New applications of secretolytics in complex therapy of acute obstructive bronchitis in children of early age

АСТМА ТА АЛЕРГІЯ, No 4 • 2013 Over a billion cases of acute respiratory infections are detected in the world annually,and the prevalence of respiratory diseases in children is 6-fold than in adults [1]. According to official World Health Organization statistics pathology of the respiratory system ranked first in the structure of infant morbidity [2]. The incidence of bronchitis predominates in 1 to 3 ege and ranges from 75 to 250 per 1000 children [1]. Acute bronchitis is an inflammatory lesion of the bronchi, mainly infectious origin, manifested by cough (dry or sputum) and lasts up to 3 weeks. Today acute obstructive bronchitis is the most common disorder of the respiratory system in children [2, 4]. Recurrences of wheezing are observed in almost 30 % of pediatric patients, and more than half of young children during acute bronchitis manifest signs of bronchial obstruction syndrome [5]. The most common cause of bronchial obstruction syndrome in children during the first three years of life are infectious agents and allergy. Among infectious agents respiratory viruses (parainfluenza types 1-3, RS-virus, adenovirus, influenza A and B), measles virus, Mycoplasma pneumoniae, Chlamydia pneuininiae, Bordetella peitussis, Hemophilus influ­ enza, Streptoccocuspneumonia, Streptococcus pyogenes, Moraxella catairhalis are encountered [4]. Increasing the viscosity of secretions, its accumulation in the lumen of the bronchi, swelling of the mucous membrane of the bronchial tree and bronchoconstriction are the various underlying mechanisms of pathogenesis of bronchial obstruction syndrome . There is also reducing the refractive power of the lungs on exhalation, decreased mucociliary transport, airway compression. In the case of any adverse effects on the respiratory tract takes place, a violation of bronchial secretion develops, increased production of secretions and increase of its viscosity, the accumulation of viscous secretions in the lumen of the bronchi leads to difficulty in air passing [5, 6]. Hipereksudation is more expressed in children of preschool age. This is the main difference between the flow of obstructive bronchitis in children, unlike adults, for whom the phenomenon of bronchoconstriction is common in this case. That is why the very first clinical symptoms of acute obstructive bronchitis are a cough ( as a result of reflex reaction to the irritation of the vagus nerve receptors and manifestation violation mucociliary transport), dyspnea (as a manifestation of bronchoconstriction and lung aeration violation), and intoxication syndrome, which depends on the severity of infection[1, 2]. Treatment of acute bronchitis with obstructive syndrome is a complex clinical task, that have to be carried out without polypharmacy, as in pediatric patients it is the most common cause of antibiotics abuse. The use of antibiotic therapy for acute bronchitis is not recommended either the American College of Physicians (2001) or the American College of Chest Physicians (2006) [3]. According to Centers for Disease Control and Prevention, about half of antibacterial agents prescribed by general practitioners to treat colds, coughs, and other manifestations of viral infections have no effect on pathogens. However, antibiotics, especially macrolides are used in mycoplasma infection and bronchitis of chlamydial etiology, and are the drugs of choice for confirmed pertussis. The National Pediatric Pulmonology Guidelines (Order of the Ministry of Health of Ukraine of 13.01.2005 No 18) antiviral drugs (Remantadin, Arbidol, pensamiksyn, rebetol, interferons and DNA-ase) as the causal treatment of acute bronchitis, and minimizing the use of antibiotics are recommended [3, 6, 7]. According to the recommendations of the New applications of secretolytics in complex therapy of acute obstructive bronchitis in children of early age