Broncho-obstructive syndrome in children. Causes the winninennya ta factori riziku

S.L.Babak, L.A. Golubev, M.V. Gorbunova

Broncho-obstructive syndrome (BOS) is a key symptom complex, the accumulation of damage to the passage through the bronchi in the case of sound or occlusion of the dysfunctional paths with the further reduced support of the dysfunctional paths before the luffing.

Biofeedback is one of the pathophysiological damages, which are well-known to the results and the progressive overrun of the bagatokh hospitals and chronic bronchogenic diseases. BFB, yaka є an independent nosological unit, can be developed with dear ones legends and hearts, how to produce to the point of ruin the prodigality of the dystopian nobles. The main clinical manifestations of biofeedback are attack-like cough, expiratory badness and rapid attack of breath. For the key manifestations of biofeedback, it was taken latently and against the backdrop of a twisted clinical picture. For the relocation of the biofeedback, they go to the gostry (raptovo vinik) and chronic (staly).
Functional changes in biofeedback are related to the decrease in the main spirometric parameters, which represent the steps of bronchial obstruction (BO) and the nature of the "pasta", and itself:

Obsyag forced vidihu in 1 second (FEV1);
OFV1 / FZHEL

These indicators є diagnostic criteria of bronchial obstruction and serve for the purpose of determining the severity of biofeedback.
According to the severity of the clinical and functional manifestations of the biofeedback system, the average gravity and important.
The main key manifestations of biofeedback are zadishka, poison (admitted to clutter up the life stanіv), attack-like cough, wheezing, guchne dikhannya. Symptoms are more reminiscent when physically assigned... Іnshi show biofeedback, head b_l, Integrity of svidomostі, sudomi - appear in case of severe interruption of the syndromic complex.

Variant form BOS
Spastic - the most often developed variant of biofeedback (> 70% of all types), in the development of bronchospasm through dysfunctions in the control systems of bronchial tone.
Zapalny - the mechanism of accumulation of the nabrya, the infiltration of the rotary paths, the hyperemia of the shell of the bronchial tubes.
Discrimination - to promote the overwhelming stimulation of enzymes of the cells of the bronchial tubes and the ball of the bronchial tubes, which leads to the destruction of the power of phlegm, the deterioration of the function of establishing the mucus and mucocilia.
Diskineticheskiy - bronchial progression is ruined for a congenital incomplete membrane part of the trachea and bronchial tubes;
Emphysematous - supervised by the collapse (collapse) of other bronchial tubes through a decrease in light elasticity.
Hemodynamic - in case of small cola hemodynamics breakdown: in case of hypertension of pre- and postcapillaries, congestion in bronchial veins and in case of hypertensive crisis in a small amount of blood circulation.
Hyperosmolarity - to be susceptible to changes in the hydration of the mucous membranes of the bronchial tubes (inhalation of cold drink), if the osmotic concentration on the surface of the cyclin is osmotic;
In the basis of bronchial obstruction are werewolves (functional) and non-vascular (organic) wounds. Before the functional mechanisms of bronchial obstruction, spasm of smooth muscles, hypersecretion of the mucous membrane of the bronchi are reported. Spasm of smooth muscles and hypersecretion of the mucus is produced as a result of the infusion of drastic factors (pollutant, infectious agent) onto the mucus of the dysfunctional nozzles. At the end of the day, there is a mediator fired up, which fills the end of the bloating nerve and receives the vision of acetylcholine, so that it realizes its action through the muscarinic cholinoreceptors. Activation of cich receptors, wiklica, cholinergic bronchoconstriction and hypersecretion. At the stage of bronchial tubes, there is a rise in the blood vessels of the microcirculatory bed and the increase in penetration. Such a rank is the development of a mucous membrane and a mucus ball, an infiltration of ogryadny cells, basophils, eosinophils, lymphous and plasma cells.
The cough can be dry and productive. A dry cough is characteristic of the cob period of the ignition process, or the heel process. The emergence of a productive cough is indicative of impaired mucociliary disease and bronchial drainage.
In a number of infectious agents, most often suffer from obstructive syndrome, there are respiratory syncytial viruses (close to 50%), parainfluenza virus, pneumonia mycoplasma, and more - influenza virus and adenovirus.

lykuvannya BOS
Having shown biofeedback, it is directly from the ethology, it is shown as a way of accepting non-intrusive visits by eliminating bronchial obstruction for an additional inflow to the circulating component.
It is necessary to note that the turnover of bronchial obstruction begins with the stage of bronchial hyperreactivity (HRD). HRD is a manifestation of a reaction of bronchial tubes to different chemical, physical or pharmacological conditions, if bronchospasm develops in response to an infusion, but not a reaction to such a reaction in healthy individuals. Chim vishche GDB and the triviality of exposition of a provocative agent, which is more important and not safe for the life of a patient against biofeedback.
In modern pulmonology, there is a highly effective way of delivering drugs to the bronchi without the need for a second. This technology is called "inhalational nebulizer" (from Latin nebulae - fog) therapy. Typical її rice temporal fraction (> 80%) particles with a size of 0.5 to 5 microns, which are easy to reach the receptor zone in other bronchi and quickly reduce bronchial obstruction.
The unspeakable passes of English therapy in general є:

Effectively the stem of high concentrations of medications in dichny paths;
the concentration of the drug in the blood is insignificant;
velvet ear for preparations;
Possibility of short dosages;
minimum system side effects.

Lіkuvalnaya tactics with biofeedback is sufficient intelligence and logical. For the suppression of bronchial obstruction vikoristovuyu bronchodilator (bronchodilator). Unimportant in the mechanism of the mechanism of the development of bronchodilators who have found them in power є the health of the spasm of the muscles of the bronchi and the possibility of passing through the history of the legend. All current bronchodilators for biofeedback therapy can be divided into several main groups:

B2-agony of a short and trivial action;
holinolitics of a short and trivial action;
combined preparations;
methylxanthini.

Іngalyatsіynі b2-agony
Іngalyatsіynі b2-agony of a short story. Qia group includes two dosit selective b2-agonist - fenoterol and salbutamol. The main authorities of the group of drugs are:

Relaxation of bronchial smooth muscles;
Decrease of hyperreactivity of dyshly shlakhiv;
polypieshennya mucociliary bronchial cells;
lowering of the permeability and exudation of plasmas;
change in the mucous membrane of the bronchi;
stabilization of the membranes of the ogryadnye cells, replacement of the wikid of mediators firing.

Perevagami cich preparation є shvidky (after 3-5 minutes) і bends bronchodilator effect. The triviality of these drugs is not great, they become from 3 to 6 years old, which is considered to be a group of short-range b2-agonists (CDBA). Obviously, if there is a need for effective control of bronchial education for 24 years, it is necessary to go from 4 to 8 inhalations of CDBA for additional purposes.
However, as if it were b2-agony, the preparations of the whole group may have a greater number of side effects, especially with frequent (more than 4 times per day).
One of the most serious side-by-side b2-agonist є tremor due to direct drug on the b2-adrenergic receptor of skeletal muscles. Tremor is often associated with children of a kidnapped and old man. Tachycardia is not frequently observed - either as a result of direct action on the b-adrenergic receptor at the atrium, or as a result of an infusion of reflexive symptoms of peripheral vasodilatation through the b2-receptor. I especially respect the slid of the beasts on the podovzhennya interval Q-T, Zdatne wiklicati rapt death in patients with cardiovascular pathology. More rapid and less rapid turnarounds є hypocalypse, hypoxemia and gravity. In addition, the b2-agony of a short period of power is a manifestation of tachyphilaxis - a decrease lіkuvalnogo efectu in case of repeated consumption of drugs.
Іngalyatsіynі b2-agony trivaloi dії. The drugs of the whole group may be trivial from 12 to 24 years old and they can be stored in the warehouse of basic therapy for sickness, most often they are accompanied by biofeedback, for example, bronchial asthma (BA). It is most effective in the complex with anti-pyretic drugs - inhalation glucocorticosteroids (IGCS). On the current day, the combination of LABA + IGS is recognized as an effective basic therapy for BA.
Naybіlsh yaskravim predstavnikom tsієї groupies Je formoterol fumarate (formoterol) yaky Got zdatnіst rozslablyuvati smooth muscle bronhіv, posilyuvati mukotsilіarny klіrens, zmenshuvati sudinnu proniknіst i vivіlnennya medіatorіv іz stovburovih klіtin i bazofіlіv, zabezpechuvati trivaly Zahist od vplivu faktorіv scho prizvodyat to bronchospasm. However, there is not enough evidence that formoterol is infused with persistent inflammation in BA; In addition, in a number of times it is shown that in case of a trivial zasosuvanny the swelling of the bronchodilator effect can be strong.
Non-desirable effects of LABA are not strongly associated with such in LABA, develop when the average recommended doses are transplanted and appear in vigilants, almost like trivialities, tremors of skeletal mucous membranes, stimulation heart-vascular system.

Іngalyatsіynі M-holіnolіtiki
English Holinolitics of a short series. The main representative of the whole group - short-term anticholinergic drugs (CDAH) - is called ipratropium bromide (ipratropium), which is volodymy with bronchodilator effects.
Mechanism of bronchodilator enlargement by the blockade of muscarinic cholinergic receptors, as a result of which reflexive bronchial ulceration is caused, in the absence of irritation of the inflammatory cholinergic receptors, and tonic reduction.
Practically in all published instructions for the purpose of BA, holinolitics in the use of "vibor preparations" for the treatment of this incapacitation, as well as in pre-adolescent Bronchodilating cattle in cases of FOS in the middle of such a severe stage.
The unspeakable passes of M-holinolitikiv є:

The appearance of cardio-toxicity, how to rob them with "vibration drugs" for patients with heart and circulatory systems, as well as for young patients;
visibility of tachyphilaxis in case of repeated consumption;
stable receptor activity (the number of M-cholinoreceptors does not change in any case, but the number of b2-adrenergic receptors depends on the number and activity);
There are fewer effects (dryness, hot gusto at roti).

Positive efficacy of holinolitics is not limited to bronchodilator efficacy. The stench swirls in the decreased sensitivity of cough receptors, changes in the secretion of viscous phlegm, and changes in the salivary sourness of dysfunctional meats. Before the number of positive features of ipratropium bromide, there is a great triviality of days - up to 8 years.
Let us be smart about the short-lived M-holinolitics of a short period or a short series of anticholinergics (CDAH) є an ear of cob (after 30-60 minutes) when ingestion, so that the rapid reduction of biofeedbacks is quickened.
Іngalyatsіynі M-holіnolіtiki trivaloi dії. The main representative of the whole group - dovotrivalі anticholinergic drugs (DDAH) - know thyotropy bromide (thiotropy), which is trivial and strong bronchodilator effects.
Tіotropіy dozіlno zastosovuvati for the reduction of biofeedback with "important refractory BA", if high therapeutic doses of b2-agonists do not give good bronchodilation and do not know biofeedback.

combined bronchodilators
Ingestion combination of short-acting bronchodilators. The main representative of the group - shortly combined bronchodilator drugs (CDKB) - is the combination of CDAH (ipratropy 20 mcg) + KDBA (fenoterol 50 mcg), which has been widely expanded in the course of practice і "Berodual" in the form of a rosette for іngalyatsіy (company Berіnger Engelheim, Nіmechchina).
The idea of combining KDAH + KDBA is not new; To deliver tales about the high degree of salbutamol + ipratropium, so they did not know their own wide sucking... It is very important to mention a number of special features of combining fenoterol and ipratropium.
According to the first, M-holinolytics of ipratropy volodin are important in the proximal bronchial tubes, while the selective b2-agonist fenoterol is important for distal views bronchial tree. It is necessary to bring bronchodilatation up to the "subordinate effect", the possibility of reducing the dose of the skin preparation to the minimum therapeutic, assimilating the possibility of third-party non-essential manifestations. In another way, offending speeches may, however, be the same as the aggregate mill (water pressure), which allows a high respiratory fraction in the course of nebulizer therapy, and that means effectively eliminating biofeedback.
Primed for the drug Berodual for the suppression of biofeedback in asthma in the onset of symptoms:

The presence of a changed b2-receptor in patients (genetic Abnormal b2-receptor, as a substitute in 16 positions of Gly on Arg with the form of the b2-APB16 Arg / Arg receptor genotype, which is not sensitive to b2-to-be-agon)
with a change in receptor b2-activity;
with the presence of swelling manifestations of the heart-vindicated ailments;
with symptoms of "low asthma" (options for asthma, with any attack of breath, in the other half of the night, on the other half of the night on the bronchial obstruction, viklican activity of the vagus);
at in Russian infections In the past, the expression of the M2 gene and the development of bronchial obstruction is increased.

It is of interest to present randomized clinical advances, which ensure the effectiveness of combined therapy in terms of monotherapy with one of the components. So, in a randomized controlled crossover reading N. Gross and spivavt. Including 863 illnesses, the combined therapy led to an increase in FEV1 by 24% in the cases of monotherapy with salbutamol (RV in the last few days (meta-analysis of two great 3-month therapies) (1999). Biofeedback in patients with chronic obstructive chronic obstructive diseases (COPD). Established that with monotherapy with salbutamol, the frequency of chronic chronic obstructive diseases (18%) ) (By such a rank, Berodual H looked like a drug, which is a good choice for high spirits / efficiency. CLINIC RECOMMENDATIONS for the treatment of patients with bronchial asthma COPD.
Unspeakable reports by the passes of Berodual N і Berodual razchin for іngalyatsіy є:

Shvidky (after 5-10 hours) і finish the trivial (6-8 hours) effect;
safe clinical profile (visibility of cardio toxicity);
lack of tachyphylaxis;
visibility into the mortality rate of summer patients (as per b2-agony);
I will change the anti-firing show (change of vivile mediators fired);
more rotations of bronchodilator type in combination, lower in the skin preparation okremo;
It is ineffective to suppress acute biofeedback (with BA) and chronic biofeedback (with chronic obstructive ailments, chronic obstructive pulmonary disease - COPD).

methylxanthini
The main representative of the group is known as bronchodilator, lost purine, under the name Teofilin (from Latin: theo-tea, phyllin-leaf). Theophilin robbing a weak bronchodilator effect, a little positively infused into the spinal muscles, reducing the appearance of phlegm, stimulating the spinal center. To get more positive authorities, the order with the availability of theophilia was called up to the widest victorian.
Methylxanthine intake of superfoods side effects: Nudota, blues, headache, lesions, gastroesophageal reflux, frequent sechovies, Arithmієyu, takhіkardієyu etc. The drug should be stuck in the middle or parenterally.
The drugs theophilin of the prolonged day went to a different plan. Їx recommended in in particular vikoristovuvati in the capacity of pre-infantile bronchodilatory disease in patients with biofeedback in patients with asthma and COPD with lack of bronchodilating type of bronchodilator therapy.

visnovok
BFB supervodzhu large ailment, especially ill mental systems, Such as bronchial asthma, COPD, GDVI, pneumonia and in. All the stench vimagayut all kinds of medication corrections.
By the standard of biofeedback treatment, it is possible to improve the intake of inhalation drugs and the nebulizer delivery method, allowing the maximum concentration lykarskoy speech in the receptor zone and in the wickle, the maximum bronchodilator appearance during the daytime of the systemic disease.
Winning biofeedbacks will take on the fate of development nervous system: Sympathetic (b-receptor) і parasympathetic (M1-2 і M3-receptor). It is often important to achieve this because it is important to rely on the mechanism of bronchial obstruction: lack of adrenergic stimulation or superficial vagal innervation. In this regard, the optimal combination of b2-agonist of a short period and M-cholinolytics is ipratropium bromide (Berodual N).
It is possible to say that Berodual N in the form of a dosed aerosol inhaler and Berodual roses for inhalation through a nebulizer is indicated for the prevention and symptomatic treatment of obstructive chronic diseases, such as bronchospasm. obstructive bronchitis, Bronchial asthma, chronic obstructive lung ailments.

literature
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2. Barnes P.J. New concept in the pathogenesis of bronchial responsiveness and asthma. J. Allergy Clin. Immunol. 1989; 83: 1013-1026.
3. Lukina O. F. Functional diagnostics of bronchial obstruction in children. Respiratory illness. 2002; 4: 7-9.
4. Geppe NA Suchasni uyavlennya about the tactics of treating bronchial asthma in children. RMZ. 2002; 10: 7: 12-40.
5. Gavalov S.M. Bronchial hyperreactivity syndrome Consilium. 1999; 1: 3-11.
6. Bradley B. L., Azzawi M., Jacobson M., et al. Eosinophils, T-lymphocytes, mast cells, neutrophils, and macrophages in bronchial biopsy specimens from atopic subjects with asthma: comparison with biopsy specimens from atopic subjects without asthma and normal control subjects and relationship to bronchial hyperresponsiveness. J. Allergy Clin. Immunol. 1991; 88.
7. Savel'ev B.P., Reutova V.S., Shiryaeva I.S. Hyperreactivity of bronchial tubes according to inhalation test with histamine in children and adults. Medical Science and Methodical Journal. 2001; 5: 121-146.
8. Avdov S. The role of anticholinergic drugs in obstructive lesions. Consilium. 2002; 4: 9: 42-46.
9. Ogorodova LM, Petrovsky F. I., Petrovska Y. A. Clinical pharmacology of bronchial asthma. Atmosphere. 2002; 3: 157-160.
10. Prince NP Foradil in the therapy of bronchial asthma and COPD. Atmosphere. 2001; 1: 26-28.
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12. Gross N, Tashkin D, Miller R, et al. Inhalation by nebulization of albuterol-ipratropium combination (Dey combination) is superior to either agent alone in the treatment of chronic obstructive pulmonary disease. Dey Combination Solution Study Group. Respiration. 1998; 65: 354-62.
13. Weber E.J., Levitt A., Covington J.K., Gambrioli E. Effect of continuously nebulized ipratropium bromide plus albuterol on emergency department length of stay and hospital admission rates in patients with acute bronchospasm. A randomized, controlled trial. Chest. 1999; 115: 937-44.
14. Taylor DR, Buick B, Kinney C, et al. The efficacy of orally administered theophylline, inhaled salbutamol, and a combination of the two as chronic therapy in the management of chronic bronchitis with reversible air-flow obstruction. Am Rev Respir Dis. 1985; 131: 747-51.

The skin of a fourth child has to endure bronchial obstruction in up to 6 years, as a rule, on the GDVI wheezing and dullness I want 50% of children once in a life. Recurrent bronchial obstruction - in 25% of children Clough J.B., 1999. Scientific and practical program "Bronchial asthma in children ..." 2012 Extension of biofeedback in children of the first 6 years of life

Anatomical and physiological features of the organs of health in children early vik hyperplasia of lousy tissue of secretion of highly viscous phlegm; small amount of smooth joints; low volume of ventilation; lack of muscular immunity;

1. Disorder of the organs of the disease, infectious-ignition, allergic broncholegenic dysplasia; Primary ciliary dysplasia; Respiratory distress;

1. Infection of organs of dichannia 2. Side of sickness 3. Infection of aspiracy genesis 4. Gastroesophageal reflux ailment 5. decline 6. Helminthosis 7. Injury of the heart-vascular system 8. Injury of the nervous system 9. Immunodeficiency 10. Inshy Ethiology of broncho-obstructive syndrome Sick

The main causes of recurrent biofeedback in children with GDVI respiratory infections(Including - in BWD (often sick children) - with persistent infections) Evidence of bronchial asthma Latent interruption of chronic bronchogenic illness (cystic fibrosis, Kartagener syndrome, etc.)!

Vіkovy aspect of the competence of diagnostics: “ГРІ. Obstructive bronchitis. DN ... "obstructive bronchitis (self-reliant nosological form current health conditions) ailments, as a rule, children of the first 4 - 5 years of life with obstructive bronchitis (as an independent nosological form interrupting the health conditions)

Acceptable factors: catching of intrauterine development prematurity SDR + ShVL (triviality, adequacy) of immunodeficiency:

key picture- symptoms of GDVI - nonspecific: - symptoms of GDVI - nonspecific: fever of catarrhal symptoms (rhinitis, conjunctivitis - one - or two-sided), cough, pain during congestion, etc.) appetite, lowering tolerance to physical nutrition, vagotonia)

A clear picture - symptoms of expiratory discomfort on the 3-5th day of ailment (with repeated episodes of obstruction, the malaise may appear on the first day) - symptoms of expiratory discomfort for 3-5 days of ailment (with repeated episodes of obstruction of the disease, day) dichannyazhorstka with a great number of whistling and wheezing - totally. Vologі m / n (і s / n) wheeze more often, what the young child signs of DN (tim more turns, what the young child) is a boxy Legendary sound through the ventilation emfizemi. Breast cage improved in front to rear rozmіrі

Laboratory indicators Laboratory indicators neutropenia + lymphocytosis - GDVI leukocytosis + lymphocytosis + N SHOE - whooping cough? neutrophilic leukocytosis - attribution of bacterial flora cytology of nasal secretion - eosinophilia? blood gases do not fluctuate rapidly

Differential diagnosis Differential diagnosis of BA - debut? mucoviscidosis - (pilocarpine test-chlorides) obliterated bronchitis (zonal rheography of legends) foreign micro-aspirations of clinical manifestation in the development of the bronchogenic system

Bronchial asthma - pediatric asthma problem is more widespread in the middle of children, lower in the middle of older adults. V childish for BA, 90% of all types of broncho-obstructive syndrome fall. In 27-33% of BA patients, it is up to 1 rock, in 55% of cases - up to 3 rock, in 80-85% - up to 6 rock. The school's and adult's BA has a debut earlier. (Delyagin V.M., Rumyantsev A.G., 2004) However, BA naybilsh common reason state hospitals in school and children.

Broken-winded dihalnih shlyahіv at astmі alergija / Triger broken-winded Zvuzhennya dihalnih shlyahіv (obstruktsіya) symptoms Svistyache dihannya Zadishka Pochuttya soromu at breasts cough symptoms often rozvivayutsya in nіchnі Godin Medіatori broken-winded Klіtini broken-winded Eozinofіli T lіmfotsiti Dendritnі klіtini Macrophages Neytrofіli> 100 tipіv, vklyuchayuchi: hemokіni tsisteїnu leykotrієni Cytokines (for example, IL-1β, TNF-α, IL-3, IL-4, IL-5, GM-CSF) Gistamin Nitrogen oxide Prostaglandin D2 Smooth cells Adapted from the Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention 100 types, including: chemokini cysteine leucotrine cytokines (for example, IL-1β, TNF-α, IL-3, IL-4, IL-5, GM-CSF) Histamine Nitrogen oxide Prostaglandin D2 Smooth cells Adapted from Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention. 2007.http: //www.ginasthma.org. 8 ">

Clinical criteria of BA for the manifestation of attacks of expiratory backwardness and / or wheezing, obstructed dichotomy - in case of contact with allergens - in case of infusion of nonspecific factors; - often at nighttime Difficulty of sight Suffocation Cough whistling wheezing during auscultation

What can be easily diagnosed? A wide variety of wheezing episodes in breast cells and coughing in children associated with other reasons, especially up to 2 rocks. Interconnecting the possibilities with the function of legends. Diagnostics primed on skargs, given anamnesis and look around. assessment key manifestations and the gravity of the severity of the gravity of the ground, call on the hostile 3-ї individuals. Development of asthma phenotypes.

Difficult diagnostics of biofeedback in children of early age Anamnesis (a child can be seen without sight, "vіyna semey" and inn.) functional diagnostics

Diagnostics in children younger than 5 years Base on a given anamnesis and results of clinical, rather than functional, situation. In children of breastfeeding, when there are 3 or more wheezing episodes of wheezing, associated with the same triggers, with the presence of atopic dermatitis and (or) allergic rhinitis, eosinophilia of BA in the blood, the condition of the disease.

The BA group in the early period of Shkirny show atopy on the first occasion of life. High (more than 100 IU in ml) of the standard IV-E or positive test. Fathers (іnshі relatives) ailments BA. Three episodes of obstruction and more. Obstructive episodes are often on the other hand, or during GDVI, they appear without temperature and may have an attack of a similar nature.

Anamnesis up to 2 years: guchne dikhannya, blues, tied with a cough; retraction of breasts with dikhanna; it is difficult for years to come (to beat the dick, blaspheme); tachypnoe. Anamnesis older than 2 years: badness in the afternoon or at night, stupidity, bad performance at school, decreased intensity physical activity, Improvement of the other types of activity, reaction to specific triggers, currencies.

Kriterії dіagnostiki persistuyuchoї BA bronhoobstruktivnі epіzodi Klіnіchnі manifest atopії Eozinofіlіya i (ABO) pіdvischennya ІG-E Specific target sensibіlіzatsіya to nutritive alergenіv in breast i Rann vіtsі i to іngalyatsіynih alergenіv in away Sensibіlіzatsіya to іngalyatsіynih alergenіv at vіtsі to 3 rokіv (pobutovim) Nayavnіst BA at the fathers

Infections: Chlamidin Mycoplasma Cytomegalovirus Herpetic Pneumocystis Helminthosis

1) Atopic congestion in the homeland Atopic congestion in children Sensitization to aeroallergens Small signs: (> 2) whistling xp "title =" (! LANG: (! LANG: Bronchial asthma in children of early age for 12 months Great signs: (> 1) Atopic illnesses in the motherland Atopic illnesses in a child Sensitization to aeroallergens Small signs: (> 2) whistling xp" class="link_thumb"> 36 !}!} Bronchial asthma in children of early age Bilsh 3 episodes of whistling symptoms in 12 months FDMartines, 1995 1) Atopic incapacitation in the homeland Atopic incapacitation in a child Sensibilization to aeroallergens Small indications: (> 2) whistling xp "> 1) Atopic incapacitation in the homeland Atopic incapacitation in a child Sensible to allergic reactions to їzhі + FDMartines, 1995 "> 1) Atopic disease in the homeland Atopic disease in a child Sensitivity to aeroallergens Small signs: (> 2) whistling хр" title = "(! LANG :(! LANG: Early bronchial asthma in 3 -x episodes of wheezing in 12 months Great signs: (> 1) Atopic illnesses in the motherland Atopic illnesses in a child Sensitization to aeroallergens Small signs: (> 2) wheezing chr"> title="Bronchial asthma in children of early age Bilsh 3 episodes of wheezing in 12 months Great signs: (> 1) Atopic illness in the homeland Atopic illness in a child"> !}!}

Difficult English therapy for biofeedback in children The need for special delivery methods lykarsky zasobu: Chi does not vimag a significant zusill with inhalation of the Simple (without synchronization of inhalation) In children older than 2 years - without a mask (a mask will change the dose of the drug for sitting in an empty nose).

Ingestion therapy of obstructive organ diseases lykarsky drug lung Vіdsutnіst bіotransformatsії lіkarskogo preparation (zv'yazuvannya bіlkami krovі, modifіkatsіya pechіntsі in that іn.) to cob Yogo dії Znizhennya virazhenostі sistemnoї dії Liky Zmenshennya zagalnoї Dozy preparation scho administered patsієntovі Nedolіki Neobhіdno navchannya ailing tehnіtsі vikonannya іngalyatsіy Efektivnіst lіkuvannya deposits not tіlki od the mechanism of the drug, ale and in the form of its delivery to the target organ. Possibilities of muscular draining high dosage (80%) of the deposition of medications in the orthoglottic Potency of delivery of large doses Pomki, which are allowed by patients

Frequency of pardons, scho admitted by ailments with victorian DAЇ Etapi correct sucking Inhaler Punches, which are allowed by the patients (in%) To take care of the little girl 7 Inhaler 43 to look at the inhalator 29 To grow up in the mouth with his lips clenched 29 To the act of inhalation 64 To take a lick on the cob To inhale 5 (D. Ganderton, 1997)

Algorithm for eliminating vascular obstructions Krok 1 2 agonist or 2 agonist + ipratropium bromide 2 agonist or 2 agonist + ipratropium bromide (aerosol dosages - salbutamol, fenoterol, berodual) without spacer-4 , salbutamol, fenoterol - 0.5 - 1.0 ml) or

Algorithm for the treatment of vascular obstruction Krok 1 in the middle: salbutamol, or internal: orciprenaline Assessment through hilin: effect є - susceptible therapy, effect is mute - Krok 2

Evaluation of the effectiveness of therapy for obstruction of the reduction of RR to sickness in the absence of distant noise and decrease in the abundance of wheezing during auscultation in the future - normalization of the temperature at the time of the decrease until the 5-7 days of obstruction

Algorithm for the treatment of vascular obstruction Croc 2 repeated dose of 2 agonist or 2 agonist + ipratropy bromide: 2 agonist or 2 agonist + ipratropy bromide: Assessment through chilin: Evaluation through chilin: efficacy

Algorithm for the treatment of vascular obstruction Croc 3 Systemic glucocorticosteroids in / m: Dexamethasone 0.5 - 0.75 mg / kg or prednisolone 3 - 5 mg / kg Assessment through quiline: Adaptive therapy

Algorithm for the elimination of vascular obstructions during therapy: 2 agonist + ipratropium bromide (aerosol Berodual) 2 agonist + ipratropia bromide (aerosol Berodual) or 2 agonist (aerozol), allredin) (allredin) mg / kg 3 times for dobu

Pathogenetic treatment of obstructions at the stage of adolescent therapy ІKS (pulmicort through a nebulizer) - give rise to 2 problems - evidence (for the period of protection signs of obstruction) In children with an allergy to anxiety in the family

The head meta-treatment of a sick person with bronchial asthma, as a result of a single patient's disease, is subject to complete control. From asthma it is not possible to find it, but it is possible and necessary, to control your camp, to live in everyday life without stagnation of short-lived β 2-agonies, without burning ailments, without any awakenings and without acceleration. Tsiomu is guilty of taking control (anti-firing) therapy

Pidbir basic therapy The basic therapy is aimed at combating the main pathogenetic lanka of BA - allergic inflammations (synonymic control or preventive therapy). In the situation with skin ailments, it is necessary to be pragmatic before the basic therapy has become uncontrolled. It’s victorious to step up to the stage. The triviality of basic therapy should not be less than three months. Please check the list of all types of delivery.

1. Zahvoryuvannya organ_v dikhannya:

Infectious and ignited ailments (bronchitis, bronchialitis, pneumonia).

Allergic illness (asthmatic bronchitis, bronchial asthma).

Broncholegenic dysplasia.

Defects in the development of the bronchogenic system.

Puffy trachea and bronchial tubes.

2. Side of the trachea, bronchial tubes, stravohode.

3. Injury of aspiracy genesis (or aspiracy obstructive bronchitis) - gastroesophageal reflux, tracheopathic fistula, malformations of the shlunkovo-intestinal tract, diaphragmatic hernia.

4. Infestation of the heart-vascular system and congenital and full-bodied character (CHD with hypertension of small blood circulation, abnormalities of sudin, etc.)

5. Ingestion of the central and peripheral nervous systems.

6. Decrease anomalies of exchange.

7. Vrodzheni and nabuty immunodeficiency stania.

8. birth: Lawrence-Moon-Bardi-Bidl syndrome, Kartagener syndrome and іn.

9. Інші cases: injuries and opіk. Otrunnya.

Influenced by the new physical and chemical factors of the new middle age.

Health of the trachea and bronchial tubes of the postgenetic progression.

3. From a practical point of view, in the presence of ethiological pathogenetic mechanisms, it is seen 4variants for broncho-obstructive syndrome:

Infectious, which develops as a result of viral and (abo) bacterial inflammation in the bronchi and bronchial tubes;

Allergic, which develops in the form of spasm and allergic inflammation of bronchial structures with spastic manifestations over the ignition;

Obturation outside body, When bronchial tubes are pressed;

Hemodynamic, such as vinikє with heart failure for livoshlunochkova type.

4. Manifest broncho-obstructive syndrome of the same type, unaffected by business ethiological officials, І pathogenetic mechanisms of obstruction. Cardinal symptoms:

Most often it is an expiratory backbone in the way of moving a support for air flow through pathology of other and middle bronchial tubes, or a small number of drops instead of a slurry into the bronchial lumen (on the site of GERKH). It is more likely to be inspiratory in case of pathology of great bronchial tubes, trachea and heart;

Asphyxiation yak the extreme steps of the ONE (I will be introduced to the threatening life);

Attack-like cough with phlegm (or without it);

Guchne dikhannya (Vizinga);

Distant wheezing.

More rarely manifest broncho-obstructive syndrome - symptoms of hypercapacity (development of pc02): headache, sleep disturbance, increased fatigue, tremor: in important cases - lump of homeopathy, judgment.

5. Obstructive syndrome with such forms of respiratory allergies bronchial asthma atopic character. Obstructions in this case are manifested by the spasm of other bronchial tubes and bronchial tubes (thin type) and in the menshy world - hypersecretory and bulging. Fitted for allergic ailments, droopiness, strained allergological anamnesis allergic rhinitis, Laryngitis, tracheitis, bronchitis, intestinal allergies), the appearance of a link to a disease with a causally significant allergen and the appearance of such a link from an infection, a positive effect, a recurrence

For a classy picture, the following are characteristic: the appearance of bronchial infections, shortness of wheezing, expiratory backache due to the participation of additional musculature, in the lungs, there is also a lack of wheezing in the lungs. An attack of vinikє, as a rule, on the first day of acute illness and liquidation in short lines with adequate therapy (salbutamol, berotek and in.). Cardinal signs of bronchial asthma are attacks of breath, eosinophilia of blood and phlegm, the manifestation of allergic or polypotic rhinosinusitis, a positive test for the appearance of bronchospasm. Criteria, as well as the results of allergological conditions, differential diagnostics bronchial asthma with asthma-like bronchospasm in carcinoma syndromes, in case of trachea or bronchial infections by foreign body, crushed by swelling, swollen lymph nodes, aortic aneurysm.

6. COPD- diffusely progressive inflamed bronchial tubes, not tied to local or generalized lesions, and manifested by coughing. About the chronic nature of the process, it is accepted to say, like a productive cough, no tying up with any one who is ill, no less than 3 months for a rick to promote 2 rocky sleep.

Main cause of COPDє trivial kurinnya, how to repeat the saw (in the minds of robots, for example, in textile, outdoor, tyutyun factories), aggressive gases, aerosol disintegration, disaggregation. Absolutely ethiological indifference of unwelcoming climatic minds and microclimates (great number of temperatures and vologosti of food and drink).

The form of bronchial asthma COPD appears, the first for everything, the appearance of attacks of poison - for COPD is characterized by a persistent cough and an indolence. When bronhіtіcheskіe varіantі COPD rіznitsya mіzh rankovimi i vechіrnіmi pokaznikami pіkfloumetrіі znizhena (varіabelnіst less then 15%) perevazhaє nezvorotny component bronhіalnoї obstruktsії at bronhіalnіy astmі - pіdvischena (varіabelnіst bіlshe 20% vkazuє on pіdvischenu reaktivnіst bronhіv) krіm, for COPD not harakternі suputnі alergіchnі sickness, eosinophilia of blood and phlegm.

- a complex of symptoms, which are characterized by damage to the passage of the bronchial tree of functional or organic walking. Clinically, it is manifested by prolonged and noisy vidih, attacks of breath, activation of pre-dyshal muscles, dry or unproductive cough. The main diagnosis of broncho-obstructive syndrome in children includes a collection of anamnestic data, an observational examination, radiography, bronchoscopy and spirometry. Likuvannya - bronchodilator pharmacotherapy with β2-adrenergic agents, the assertion of a leading ethiological factor.

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Broncho-obstructive syndrome (BOS)- a key symptom complex, which is characterized by an ulceration or occlusion of the bronchial tubes of small calibers due to the purchase of secretions, draining of the wall, spasm of smooth muscle muscles, a decrease in the mobility of the lung structure and a decrease in the mobility of the lung structure. BFB is an extension of the pathological stance in pediatrics, especially in the middle of children in children up to 3 years. Good news about statistical data, on gostrich zahvoryuvan dichotomous biofeedback systems are developed in 5-45% of cases. With the presence of a long history of data, the indicator becomes 35-55%. The forecast for biofeedback is variably and without the need to lie in ethology. In some cases, there may be more clinical manifestations on the basis of adequate ethiotropic treatment, in others, the chronicity of the process, inability and lethality, may be prevented.

cause

The main reason for the development of broncho-obstructive syndrome in children is infectious disease and allergic reactions. In the middle of GDVI bronchial obstruction, parainfluenza virus (type III) and RS infection are most often provoked. іnshі ymovirni reasons: Congenital wadi of the heart and bronchogenic system, RDS, genetic discomfort, immunodeficiency disease, bronchogenic dysplasia, aspirations of side diseases, GERH, round helminthes, hyperplasia of the region lymphatic universities, New bronchial tubes and adjacent tissues, pobichna diya medicines.

Among the main causes of broncho-obstructive syndrome in children are seen by officials, as the sutta is to move the development of the disease and to lose it. In pedіatrії to such nalezhat genetichna skhilnіst to atopіchnih reaktsіy, Passive kurіnnya, pіdvischena reaktivnіst bronhіalnogo tree i Yogo anatomical and fіzіologіchnі osoblivostі in Kindergarten vіtsі, gіperplazіya vilochkovoї zalozi, defіtsit vіtamіnu D, vigodovuvannya PIECE sumіshami, defіtsit masi tіla, vnutrіshnoutrobnі zahvoryuvannya. All the stench of good health will fill in one one on the body of the child and will fill the broncho-obstructive syndrome in children.

Pathogenetic broncho-obstructive syndrome in children can be associated with an ignition reaction of the bronchial wall, spasm of smooth muscles, occlusion or compression of the bronchus. Visceral mechanisms of building up bronchial illumination, destruction of mucociliary clearing and thickening of secretion, clogging of mucous membranes, destruction of the epithelium in the great bronchi and other hyperplasia. Yak result is the development of loss of passing, dysfunction of the lungs and dysfunctional lack.

Classification

It is related to the pathogenesis of broncho-obstructive syndrome in children who see the onset of pathology:

BFB of allergic genesis... Diagnosis on aphids of bronchial asthma, hypersensitivity reactions, polynosis and allergic bronchitis, Leffler's syndrome.
Biofeedback, viklicaniy Infectious diseases ... The main reasons: medical and chronic viral bronchitis, GDVI, pneumonia, bronchitis, bronchiectasis.
The biofeedback, which has developed on aphids of low or low-grade illnesses... Most often cystic fibrosis, lack of α-antitrypsin, Kartagener and Williams-Campbell syndromes, GERKH, immunodeficiency stania, hemosiderosis, myopathy, emphysema and anomalies in bronchial development.
Biofeedback, wines as a result of neonatal pathologies. Most often it forms on aphid SDR, aspiracy syndrome, stridor, grisha diaphragms, tracheoesophageal fistula, etc.
BFB as a manifestation of nosologies. Broncho-obstructive syndrome in children can also be provoked by foreign bodies in the bronchial tree, thymomegaly, hyperplasia of regional lymph nodes, good or malignant new bronchial tissue or soft tissue.

For the triviality of overcoming broncho-obstructive syndrome in children, they tend to:

Gostriy. A clever picture should not be more than 10 dB.
Lingering. Signs of bronchial obstruction appear for 10 days and more.
Recurrent. Gostriy BOS vinikє 3-6 times per pic.
Permanently relapsing. It is characterized by short remissions between episodes of protracted biofeedback, or more often during the day.

Symptoms of biofeedback in children

The clinical picture of broncho-obstructive syndrome in children is quite abundant in what to lie down as the main discomfiture. given pathology... The child's out-of-the-box camp in a large vipadk is medium-heavy, the child is susceptible to weakness, dullness, sleep deprivation, loss of appetite, signs of intoxication, etc. characteristic symptoms: Guchny guchne dikhannya, wheezing, when you hear a loud noise, a specific whistle when you see it.

Also, the fate of the pre-domous muscles in the act of dysfunction, attack apnea, dyspeptic (often) abnormal character, dry or unproductive cough is also promoted. With a prolonged interruption of the broncho-obstructive syndrome in children, a barrel-shaped chest wall- extension and design of mid-ribbed areas, horizontal direction of ribs. Already from background pathology, there may also be a fever present, lack of muscle mass, slimy or gnarly vision from the nose, often ziguvannya, bluishness, etc.

diagnostics

Diagnostics of broncho-obstructive syndrome in children is based on the collection of anamnestic data, active pre-examination, laboratory and instrumental methods. When living with a mother by a pediatrician or a neonatologist, emphasize respect for various ethiological factors: chronic incapacitation, developmental problems, allergies, episodes of biofeedback in the past, etc. Percussion viznachatsya to make the sound of the legendary right up to the tympanic. Auscultatively, the picture is characterized by a severe or weakening dichannyam, dry, whistling, in children - dibnokalibernymi rales.

Laboratory diagnostics for broncho-obstructive syndrome in children, including back-to-back analyzes and additional tests. In the UAC, as a rule, there are nonspecific changes that can lead to the presence of a burned out: leukocytosis, without the leukocyte formulation left, increased by the SHOE, with the presence of an allergic component - eosinophilia. If it is uncomfortable to establish the exact ethiology, additional analyzes are shown: IPA for IgM and IgG values up to infectious agents, serological tests, test for indications of chloride levels in cases of susceptibility to D.

mid instrumental methods If you can get stagnant with broncho-obstructive syndromes in children, the most frequent radiographs of OGK, bronchoscopy, spirometry, and more - CT and MRI. Radiography gives the possibility of expanding the roots of the legends, signs of a congenital lesion of the parenchyma, the manifestation of a new solution of enlarged lymph nodes. Bronchoscopia allows the appearance and appearance of side effects from the bronchial tubes, assessment of the passage of the mucous membranes. Spirometry is carried out in case of a trivial interruption of the broncho-obstructive syndrome in children with the assessment of the function of external dysfunction, CT and MRI - with low informativeness of radiography and bronchoscopy.

Likuvannya, forecast and prevention

The treatment of broncho-obstructive syndrome in children is aimed at the prevention of factors that cause obstruction. Independently from etiology, in all types of cases, hospitalization of the child is shown, and inadvisable bronchodilator therapy for patients with β2-adrenergic drugs. There may be anticholinergic drugs, corticosteroids, systemic glucocorticosteroids. Mucolytic and antihistamines, methylxanthini, infusion therapy... For the development of broncho-obstructive syndrome in children, ethiotropic therapy is indicated: antibacterial, anti-tartar, anti-tuberculous disease, chemotherapy. In the vicinity of the vipadas you can promptly involved... With the presence of anamnestic tributes, it is possible to use a third party dickheads, Zd_ysnyuєtsya ekstrena bronchoscopia.

The prognosis for broncho-obstructive syndrome in children is severe. Chim youngsha ditina - tim more important than yogo stan. Likewise, the biofeedback result is abundant in what to lie in the background disease. In case of obstructive bronchitis and bronchiolitis, as a rule, ovulation is prevented, and hyperreactivity of the bronchial tree is rarely observed. Biofeedback in case of bronchogenic dysplasia is supervised by partial GDVI, but most often it is stabilized to the yardstick. 15-25% of these children will transform into bronchial asthma... Without a mediocre BA, there is an easy transition: it is an easy form to turn into remission even in a young school age, it is important, especially in the case of inadequate therapy, characterized by deterioration of the quality of life, regular aggravations with a fatal result in 1-6%. Biofeedback on aphids obliterating bronchialitis is often caused to emphysemia and progressive heart failure.

Prophylaxis of broncho-obstructive syndrome in children on the basis of the inclusion of all potential ethiological factors, as well as minimization of these factors injected onto the child's body. So the yak itself is antenatal protection of the fetus, the planning of the family, medical and genetic counseling, rationally storing medicines, early diagnosisі adequate treatment of hospitality and chronic illnesses of the mental system, etc.

Broncho-obstructive syndrome (BOS) is a key symptom complex, which is characterized by sore throats and occlusions of bronchial tubes in small calibers as a result of buying up secretions, sweating the walls, spasm of smooth healthy muscles, and altered BFB is an extension of the pathological stance in pediatrics, especially in the middle of children in children up to 3 years. For example, due to the growing statistical data, on the other hand, the state of health of the mental system and biofeedback system is developed in 5-45% of cases. With the presence of a long history of data, the indicator becomes 35-55%. The forecast for biofeedback is variably and without the need to lie in ethology. In some cases, there may be more clinical manifestations on the basis of adequate ethiotropic treatment, in others, the chronicity of the process, inability and lethality, may be prevented.

Causes of broncho-obstructive syndrome in children

The main reason for the development of broncho-obstructive syndrome in children is infectious disease and allergic reactions. In the middle of GDVI bronchial obstruction, parainfluenza virus (type III) and RS infection are most often provoked. INSHI ymovіrnі reasons: vrodzhenі wadi Serce i bronholegenevoї system RDS genetichnі zahvoryuvannya, іmunodefіtsitnі mills, bronholegenevoї displazії, aspіratsіya storonnіh til, GERH, kruglі gelmіnti, gіperplazіya regіonarnih lіmfatichnih vuzlіv, novoutvorennya bronhіv i lay tkanin, pobіchna exposure The medikamentіv.

Classification of broncho-obstructive syndrome in children

It is related to the pathogenesis of broncho-obstructive syndrome in children who see the onset of pathology:

1. BFB of allergic genesis... Diagnosis on aphids of bronchial asthma, hypersensitivity reactions, polynosis and allergic bronchitis, Leffler's syndrome.

2. BOS, viclikaniy of infectious diseases... The main reasons: medical and chronic viral bronchitis, GDVI, pneumonia, bronchitis, bronchiectasis.

3. The biofeedback, which has developed on aphids of low or low-grade illnesses... Most often cystic fibrosis, lack of α-antitrypsin, Kartagener and Williams-Campbell syndromes, GERKH, immunodeficiency stania, hemosiderosis, myopathy, emphysema and anomalies in bronchial development.

4. Biofeedback, wines as a result of neonatal pathologies. Most often it forms on aphid SDR, aspiracy syndrome, stridor, grisha diaphragms, tracheoesophageal fistula, etc.

5. BFB as a manifestation of nosologies. Broncho-obstructive syndrome in children can also be provoked by foreign bodies in the bronchial tree, thymomegaly, hyperplasia of regional lymph nodes, good or malignant new bronchial tissue or soft tissue.

For the triviality of overcoming broncho-obstructive syndrome in children, they tend to:

Gostriy. A clever picture should not be more than 10 dB.
Lingering. Signs of bronchial obstruction appear for 10 days and more.
Recurrent. Gostriy BOS vinikє 3-6 times per pic.
Permanently relapsing. It is characterized by short remissions between episodes of protracted biofeedback, or more often during the day.

Symptoms of broncho-obstructive syndrome in children

The clinical picture of the broncho-obstructive syndrome in children is quite abundant in what to lie down as the main discomfort or factor, which is provoked by the pathology. Zagalniy camp of a child in a large vipadk is moderately severe, susceptible to weakness, dullness, sleep deprivation, loss of appetite, signs of intoxication, etc. vidihu.

Also, the fate of the pre-domous muscles in the act of dysfunction, attack apnea, dyspeptic (often) abnormal character, dry or unproductive cough is also promoted. With a prolonged interruption of the broncho-obstructive syndrome in children, a barrel-shaped thorax can be formed - an enlargement and appearance of the mid-ribs, a horizontal direction of the ribs. Already from background pathology, there may also be a fever present, lack of muscle mass, slimy or gnarly vision from the nose, often ziguvannya, bluishness, etc.

Diagnosis of broncho-obstructive syndrome in children

Laboratory diagnostics in case of broncho-obstructive syndrome in children includes external analyzes and supplementary tests. In the UAC, as a rule, there are nonspecific changes that can lead to the presence of a burned out: leukocytosis, without the leukocyte formulation left, increased by the SHOE, with the presence of an allergic component - eosinophilia. If it is uncomfortable to establish the exact ethiology, additional analyzes are shown: IPA for IgM and IgG values up to infectious agents, serological tests, test for indications of chloride levels in cases of susceptibility to D.

Among the instrumental methods, which can be stagnant in case of broncho-obstructive syndromes in children, the most frequent radiography of the OGK, bronchoscopy, spirometry, and more - CT and MRI. Radiography gives the possibility of expanding the roots of the legends, signs of a congenital lesion of the parenchyma, the manifestation of a new solution of enlarged lymph nodes. Bronchoscopia allows the appearance and appearance of side effects from the bronchial tubes, assessment of the passage of the mucous membranes. Spirometry is carried out in case of a trivial interruption of the broncho-obstructive syndrome in children with the assessment of the function of external dysfunction, CT and MRI - with low informativeness of radiography and bronchoscopy.

Likuvannya, prognosis and prevention of broncho-obstructive syndrome in children

The treatment of broncho-obstructive syndrome in children is aimed at the prevention of factors that cause obstruction. Independently from etiology, in all types of cases, hospitalization of the child is shown, and inadvisable bronchodilator therapy for patients with β2-adrenergic drugs. There may be anticholinergic drugs, corticosteroids, systemic glucocorticosteroids. In the capacity of ancillary drugs, mucolytic and antihistamines, methylxanthine, and infusion therapy are stagnant. For the development of broncho-obstructive syndrome in children, ethiotropic therapy is indicated: antibacterial, anti-tartar, anti-tuberculous disease, chemotherapy. In okremikh vipadkah you can get involved quickly. With the presence of anamnestic tributes, it is possible to use a third party in a dormant way, the bronchoscopia will be activated.

The prognosis for broncho-obstructive syndrome in children is severe. Chim youngsha ditina - tim more important than yogo stan. Likewise, the biofeedback result is abundant in what to lie in the background disease. In case of obstructive bronchitis and bronchiolitis, as a rule, ovulation is prevented, and hyperreactivity of the bronchial tree is rarely observed. Biofeedback in case of bronchogenic dysplasia is supervised by partial GDVI, but most often it is stabilized to the yardstick. In 15-25% of such children, they transform into bronchial asthma. Without a mediocre BA can be difficult: an easy form to turn into remission even in a young school age, it is important, especially in the case of inadequate therapy, characterized by deterioration of the quality of life, regular aggravations with a fatal result in 1-6%. Biofeedback on aphids obliterating bronchialitis is often caused to emphysemia and progressive heart failure.

Prophylaxis of broncho-obstructive syndrome in children on the basis of the inclusion of all potential ethiological factors, as well as minimization of these factors injected onto the child's body. So the very antenatal protection of the fetus, the planning of the family, medical and genetic counseling, the rational consumption of medications, the early diagnosis and adequate treatment of the hospitals and chronic ailments of the mental system, etc.