Diagnostic algorithm in a child with BOS
1. To establish the presence of bronchial obstruction.
2. To establish the etiology of the disease that caused
BOS.
3. To conduct differential diagnosis with other possible
causes of BOS.
4. To exclude the causes of "noisy
breathing
syndrome“ not associated with BOS.
The differential diagnosis of BOS
• Most often, BOS develops in children with SARS and is a manifestation of
acute obstructive bronchitis, but it may be the first clinical manifestation of
asthma or other chronic diseases.
• Sometimes extrapulmonary causes of noisy breathing,
such as congenital
stridor, stenosing laryngotracheitis, dyskinesia of larynx, tonsils and
adenoids hypertrophy, cysts and hemangiomas of the throat,
retropharyngeal abscess, etc. are taken as obstructive symptoms.
At repeated episodes of BOS on the background of ARVI, several groups
of factors, most contributing to BOS relapses on the background of
respiratory infection are distinguished:
1.Recurrent bronchitis, which is often caused by bronchial hyperreactivity,
developed as a result of the survived ARI of the lower respiratory tract.
2.The presence of asthma, the debut of which coincides with
the development
of intercurrent acute respiratory disease.
3.Latent course of the chronic bronchopulmonary diseases (cystic fibrosis,
ciliary dyskinesia).
Acute obstructive bronchitis (OB)
•
Bronchial obstruction at OB develops on the 2-4 days of ARI already on the
background of marked catarrhal phenomena and unproductive, dry cough.
•
Dyspnea of expiratory character appears without the expressed tachypnea (40-60
per min), sometimes distant wheezing
is in the form of noisy, rattling breathing, at
percussion there is a bandbox sound, at auscultation
- the prolonged expiration, dry
whistling (musical) wheezing, mixed moist rales on both sides .
•
On chest cavity radiographs the increased pulmonary pattern is defined , sometimes
transparency is increased.
•
BOS continues for 3-7-9
days or longer, depending on the nature of the infection
and disappears gradually subsiding parallel to inflammatory changes in the bronchi.
