Clinico-functional characteristics of various forms of acute obstructive bronchitis in early childhood

The dissertation is devoted to the clinico-functional study of various forms of acute obstructive bronchitis in early childhood. The research focuses on identifying the features of clinical manifestations and biophysical changes of the nasal mucosa and nasal secret depending on the type of pathogen — typical and atypical flora — as well as on the degree of bronchial obstruction severity and the age of the child. Special attention is given to the diagnostic significance of quantitative parameters of the upper airway status and to the correlational relationships of the studied functional indicators with bronchophonography data.

The work has developed a complex of rehabilitation measures, including a combination of basic allopathic preparations (ketotifen, erespal) and homeopathic medicinal products (preparations of the "Edas" group - 104, 113, 130; Calcarea carbonica, Calcarea phosphorica), taking into account the constitutional homeopathic types of the children. Assessment markers and formalized tables have been proposed for the clarification of the type of pathogen and the severity of bronchial obstruction. The results of the study have been tested in the practice of the Regional Children's Clinical Hospital and the City Children's Sanatorium No. 1.

Respiratory pathology occupies a leading place among diseases of early childhood [2,92,82,125,141]. In the last decade, a clear increase in the proportion of obstructive bronchitis has been noted in the structure of respiratory diseases [65,70,120,129,143,156,173,271].

The syndrome of bronchial obstruction in early childhood has attracted the attention of scientists and practitioners for many years, owing to the heterogeneity of its genesis and the difficulties of diagnosis, particularly at an early age. The uniformity of clinical symptoms in acute obstructive bronchitis and other diseases accompanied by impaired bronchial patency makes verification of the diagnosis difficult, and consequently delays the timely initiation of etiopathogenetic therapy [15,2,42,71,89,120,165,213,239].

Given that the use of many traditional diagnostic methods is complicated in early childhood due to age-specific features, the question arises of developing new diagnostic programs that allow the most rapid verification of the diagnosis.

In recent decades, a significant number of works have been published devoted to the problem of the bronchoobstructive syndrome. However, a number of questions remain outside the field of vision of clinicians. On the one hand, there is no unified approach to the organization of therapeutic and rehabilitation measures; on the other hand, in recent decades, an increasing number of restrictions have appeared for the use of medicinal agents. Unfortunately, medicine to the present day lacks a unified approach to the possibility of using unconventional treatment methods at the rehabilitation stage.

We believe that the study undertaken by us will make it possible to optimize existing diagnostic and therapeutic-rehabilitation programs for early childhood with acute obstructive bronchitis.

Objective of the Study

To identify the features of clinical manifestations and changes in the biophysical parameters of the nasal mucosa and nasal secret in acute obstructive bronchitis depending on the type of pathogen, in order to develop a complex of rehabilitation measures for early childhood.

Research Tasks

1. To clarify the risk factors for the development of acute obstructive bronchitis in early childhood.

2. To identify the features of clinical manifestations of the disease depending on the type of pathogen and to establish the most frequently encountered constitutional homeopathic types in early childhood.

3. To establish the features of deviations in the biophysical parameters of the nasal mucosa and nasal secret, impairments of bronchial patency, and indicators of acoustic work of respiration in early childhood with acute obstructive bronchitis depending on the type of pathogen, the severity of bronchial obstruction, and the age of the child.

4. To identify the relationships and evaluate the informational significance of the biophysical parameters of the nasal mucosa, nasal secret, and bronchophonography parameters in order to determine their significance in impaired bronchial patency.

5. To study the efficacy of various rehabilitation complexes in early childhood with acute obstructive bronchitis.

Scientific Novelty

1. For the first time in early childhood, the features of the course of the bronchoobstructive syndrome depending on the type of pathogen of acute obstructive bronchitis have been identified.

2. Changes in the biophysical parameters of the nasal mucosa and nasal secret depending on the type of pathogen, the degree of bronchial obstruction severity, and the age of the children have been established.

3. The interdependence of changes in the biophysical parameters of the nasal mucosa and nasal secret with bronchophonography parameters has been demonstrated, indicating their role in the mechanisms of the development of acute obstructive bronchitis.

4. A complex of rehabilitation measures has been developed, including the combined use of basic allopathic drugs (ketotifen, erespal) and homeopathic medicinal products (preparations of the "Edas" group - 104, 113, 130; Calcarea carbonica, Calcarea phosphorica) for children with acute obstructive bronchitis, and its efficacy has been proven.

Practical Value of the Study

1. Assessment markers of changes in the biophysical parameters of the nasal mucosa and nasal secret have been proposed, characterizing the clinical features of acute obstructive bronchitis associated with the type of pathogen.

2. Formalized tables have been developed, taking into account the informational diagnostic value of each proposed marker, for the clarification of the type of pathogen and the severity of bronchial obstruction.

3. The most frequently encountered constitutional homeopathic types in early childhood with acute obstructive bronchitis have been established, allowing the prediction of the nature of its course.

4. Complexes of anti-relapse therapy using basic allopathic preparations (ketotifen, erespal) and homeopathic medicinal products (preparations of the "Edas" group - 104D 13, 130; Calcarea carbonica, Calcarea phosphorica) have been developed and tested at the rehabilitation stage of children.

The Following Propositions Are Submitted for Defense

In the development of acute obstructive bronchitis in early childhood, simultaneously with the development of clinical symptoms and changes in bronchophonographic parameters, disturbances of the biophysical parameters of the nasal mucosa occur, changes in the character of the crystallocgrams of the nasal secret depending on the type of pathogen, the constitutional homeopathic type, and the severity of bronchial obstruction, which remain altered for a longer period than the clinical manifestations, necessitating prolonged rehabilitation therapy.

The use of a complex of anti-relapse therapy incorporating homeopathic medicinal products, taking into account the most frequently encountered constitutional homeopathic types, increases the efficacy of the rehabilitation measures carried out.

Implementation and Testing of the Results

The results of the work were reported at the IX Russian National Congress "Man and Medicine" (Moscow, 2002); the X Russian National Congress "Man and Medicine" (Moscow, 2003); the I All-Russian Congress "Modern Technologies in Pediatrics and Pediatric Surgery" (Moscow, 2002); the XII Scientific and Practical Conference "Current Issues of Homeopathy: The Role and Possibilities of the Homeopathic Method in Healthcare Practice" (Saint Petersburg, 2002); the National Congress on Diseases of the Respiratory Organs (Saint Petersburg, 2003).

The materials of the study have been included in the training program for pediatricians at the faculty of additional and postgraduate professional education, and have been implemented in the practice of the Regional Children's Clinical Hospital and the City Children's Sanatorium No. 1.