Bronchial Obstruction in Children

 BOS Clinical Picture
• 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. 

---