What are the key symptoms of costochondritis. How is costochondritis diagnosed. What treatments are available for costochondritis. Can costochondritis be prevented. Who is most at risk for developing costochondritis.

What is Costochondritis and How Does it Affect the Chest Wall?

Costochondritis is an inflammatory condition affecting the cartilage that connects the upper ribs to the breastbone (sternum). This area, known as the costochondral junction, becomes inflamed, causing chest pain. While the condition can be uncomfortable and concerning, it is generally harmless and often resolves without treatment.

The key characteristics of costochondritis include:

• Inflammation of the costochondral junctions
• Chest pain, typically on the left side
• Tenderness when pressure is applied to the affected area
• Pain that may worsen with deep breathing or coughing

Is costochondritis the same as Tietze syndrome? While often confused, these conditions are distinct:

• Tietze syndrome typically has a sudden onset
• Pain in Tietze syndrome may spread to the arms or shoulders
• Tietze syndrome is characterized by swelling at the painful area

Common Causes and Risk Factors for Costochondritis

The exact cause of costochondritis is not always clear, but several factors may contribute to its development:

• Repeated minor trauma to the chest wall
• Overuse of the arms
• Underlying arthritis conditions
• Respiratory infections (viral or bacterial)
• Fungal infections (rare cases)
• Chest surgery complications

Are certain individuals more prone to developing costochondritis? Research suggests that:

• Women are more affected than men (70% vs. 30%)
• Children and adolescents commonly experience costochondritis
• The peak age for the condition is 12-14 years
• Children carrying heavy backpacks on one shoulder may be at increased risk

Recognizing the Symptoms of Costochondritis

Identifying costochondritis symptoms is crucial for proper diagnosis and treatment. The primary symptoms include:

• Sharp chest pain, often on the left side
• Pain exacerbated by deep breathing or coughing
• Tenderness when pressing on the rib joints
• Possible pain spreading to the back or abdomen

When should you seek medical attention for chest pain? Contact your doctor if you experience:

• Difficulty breathing
• High fever
• Signs of infection at the rib joint
• Persistent pain despite medication
• Nausea, sweating, or dizziness

Diagnosing Costochondritis: Tests and Procedures

Diagnosing costochondritis can be challenging as there is no specific test for the condition. Healthcare providers typically follow a process of elimination:

1. Physical examination to check for tenderness in the rib joints
2. Echocardiogram (ECG) to rule out heart-related issues
3. Chest X-rays to examine the lungs and ribcage
4. Blood tests to check for signs of heart damage or infection

In some cases, additional tests may be necessary:

• Gallium scan for patients with recent sternum surgery
• White blood cell count to check for infection
• Chest X-ray to rule out pneumonia

Effective Treatment Options for Costochondritis

While costochondritis often resolves on its own, several treatment options can help manage symptoms and promote recovery:

Home Remedies

• Over-the-counter pain relievers (NSAIDs like ibuprofen or naproxen)
• Application of local heat or ice
• Avoiding strenuous exercise or activities that exacerbate pain
• Gentle stretching exercises

Medical Treatments

• Prescription-strength pain medications
• Corticosteroid injections for severe cases
• Physical therapy to improve posture and strengthen chest muscles
• Treatment of underlying conditions (if applicable)

How long does it take for costochondritis to heal? The duration varies, but most cases improve within a few weeks to months with proper care and management.

Preventing Costochondritis: Lifestyle Changes and Precautions

While not all cases of costochondritis can be prevented, certain measures may reduce the risk:

• Practicing good posture
• Using proper lifting techniques
• Avoiding repetitive arm and chest movements
• Maintaining a healthy weight to reduce stress on the chest wall
• Engaging in regular, low-impact exercise

For children and adolescents, what precautions can be taken to prevent costochondritis?

• Encourage the use of backpacks with two straps to distribute weight evenly
• Limit the weight of school bags
• Promote regular breaks during studying or computer use
• Teach proper posture and ergonomics

Costochondritis in Special Populations: Children, Athletes, and Postoperative Patients

Costochondritis can affect various groups differently, requiring tailored approaches to management and prevention:

Children and Adolescents

Costochondritis is a common cause of chest pain in young people, accounting for 10% to 30% of all chest pain cases in children. Considerations for this age group include:

• Educating parents and caregivers about the condition
• Addressing potential anxiety related to chest pain
• Modifying school and extracurricular activities as needed
• Regular follow-ups to monitor progress

Athletes

Athletes, particularly those involved in sports requiring repetitive arm or chest movements, may be at higher risk for costochondritis. Management strategies include:

• Proper warm-up and cool-down routines
• Technique modification to reduce stress on the chest wall
• Gradual return to activity following recovery
• Use of protective gear when appropriate

Postoperative Patients

Individuals who have undergone chest or upper abdominal surgery may develop costochondritis as a complication. Special considerations for this group include:

• Close monitoring for signs of infection
• Gentle rehabilitation exercises as advised by healthcare providers
• Pain management strategies that don’t interfere with healing
• Regular follow-up appointments to ensure proper recovery

Long-term Outlook and Quality of Life with Costochondritis

Understanding the long-term prognosis for costochondritis is crucial for patients and healthcare providers. While the condition is generally benign, it can impact quality of life:

Prognosis

• Most cases resolve within weeks to months
• Recurrence is possible but not common
• Chronic cases may require ongoing management

Quality of Life Considerations

Living with costochondritis may affect various aspects of daily life:

• Physical activities may need to be modified
• Sleep disturbances due to chest discomfort
• Potential anxiety related to chest pain
• Impact on work or school attendance

How can patients cope with the psychological impact of costochondritis? Strategies may include:

• Education about the benign nature of the condition
• Stress reduction techniques
• Support groups or counseling if needed
• Regular communication with healthcare providers

Differentiating Costochondritis from Other Chest Pain Conditions

Chest pain can be a symptom of various conditions, some of which may be serious. Understanding how to differentiate costochondritis from other causes of chest pain is crucial:

Costochondritis vs. Heart Attack

Key differences include:

• Costochondritis pain typically worsens with movement or pressure
• Heart attack pain is often accompanied by shortness of breath, nausea, or sweating
• Costochondritis doesn’t usually cause radiation of pain to the jaw or left arm

Costochondritis vs. Pleurisy

Distinguishing features:

• Pleurisy pain is often sharp and occurs with breathing
• Costochondritis pain is typically more localized to the chest wall
• Pleurisy may be accompanied by other respiratory symptoms

Costochondritis vs. Fibromyalgia

Important distinctions:

• Fibromyalgia involves widespread pain, not just in the chest area
• Costochondritis pain is more specifically located at the rib junctions
• Fibromyalgia often includes other symptoms like fatigue and cognitive issues

When should you suspect a more serious condition instead of costochondritis? Seek immediate medical attention if you experience:

• Sudden, severe chest pain
• Shortness of breath or difficulty breathing
• Pain radiating to the jaw, left arm, or back
• Dizziness, nausea, or profuse sweating accompanying chest pain

Costochondritis — Symptoms, Causes, Tests, and Treatment for Costochondritis — from WebMD

Written by WebMD Editorial Contributors

• What Is Costochondritis?
• Costochondritis Causes
• Costochondritis Symptoms
• Costochondritis Risk Factors
• Costochondritis Diagnosis
• Costochondritis Treatment and Home Remedies
• Costochondritis Prevention
• Costochondritis Outlook
• More

Costochondritis is inflammation of the areas where your upper ribs join with the cartilage that holds them to your breastbone. These areas are called costochondral junctions. The condition causes chest pain, but it’s typically harmless and usually goes away without any treatment. But any chest pain in adults should be taken seriously, so you should be examined and tested for heart disease.

A rare condition called Tietze syndrome is often referred to as costochondritis, but the two are distinct conditions. You can tell the difference by the following:

• Tietze syndrome usually comes on all of a sudden, with chest pain spreading to your arms or shoulder and lasting several weeks.

• Tietze syndrome causes swelling at the painful area (where your ribs and breastbone meet).​​​​​​​

Doctors don’t know exactly why costochondritis happens, but they do know that some things can lead to it: 

• Repeated minor trauma to your chest wall
• Overuse of your arms
• Arthritis. Costochondritis can sometimes be a sign of osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, or other conditions that affect your cartilage.
• Tumors. These can move from joints and other parts of your body and settle in your chest.
• Respiratory infections caused by viruses 
• Bacterial infections, especially in people who use IV drugs or have had surgery near their upper chest 
• Fungal infections (in rare cases)

Chest pain linked to costochondritis usually comes on after exercise, minor trauma, or an upper respiratory infection.

• Sharp pain in the front of  your chest, near where your breastbone and ribs meet, typically on the left side. It may spread to your back or belly.
• Pain when you take a deep breath or cough. It gets better when you stop moving or your breathing is quieter.
• Tenderness when you press on your rib joints. If you don’t have this tenderness, you probably don’t have costochondritis.
•  If costochondritis happens because of an infection after surgery, you’ll have redness, swelling, or pus discharge at the site of the surgery.

Call your doctor if you have any of the following:

• Trouble breathing
• High fever
• Signs of infection such as redness, pus, and increased swelling at the rib joints
• Continuing or worsening pain despite medication
• Nausea
• Sweating
• Dizziness

Go to a hospital’s emergency room if you have a hard time breathing or any of the following. They’re not usually caused by costochondritis:

• High fever that doesn’t get better with fever reducers such as acetaminophen or ibuprofen
• Signs of infection at the tender spot, such as pus, redness, increased pain, and swelling
• Persistent chest pain of any type when you also have nausea, sweating, or pain in your left arm. These may be signs of a heart attack. If you’re not sure what’s causing your chest pain, go to the emergency room.

Costochondritis is a common cause of chest pain in children and adolescents. It accounts for 10% to 30% of all chest pain in children. Annually, doctors see about 650,000 cases of chest pain in people ages 10 to 21. The peak age for the condition is ages 12-14.

Kids who often carry heavy book bags over one shoulder can be more likely to develop costochondritis.

In adults, costochondritis affects women more than men (70% vs. 30%).  

There is no specific test for diagnosing costochondritis. To rule out a more serious cause of your chest pain related to your heart or lungs, your doctor will probably start with tests like an echocardiogram (ECG), chest X-rays, and blood test for heart damage, among others. 

If those tests come back normal, they’ll likely see if you have tenderness in any of your rib joints, usually over the fourth to sixth ribs.

If you’ve had sternum (breastbone) surgery or are at risk for heart disease, they may recommend getting a test to see if infection is the cause of your chest pain. Doctors will:

• Look for signs of infection such as redness, swelling, pus, and drainage at the site of surgery
• Recommend a more sophisticated imaging study of the chest called a gallium scan, which will show an increase in the radioactive material gallium 
• Check your white blood cell count to see if it is high, a sign of infection
• Recommend a chest X-ray if pneumonia might be a cause of your chest pain

Home Remedies for Costochondritis

These home remedies may provide relief from costochondritis:

• Over-the-counter  pain relievers such as nonsteroidal anti-inflammatory medications (NSAIDs) like ibuprofen or naproxen as needed
• Using local heat or ice to relieve pain
• Avoiding unnecessary exercise or activities that make the symptoms worse; avoiding contact sports until there is improvement in symptoms, and then returning to normal activities only as tolerated
• Doing stretching exercises

Medications for Costochondritis

Your doctor may suggest the following:

• Prescription-strength NSAIDs.
• A local anesthetic and steroid injection in the area that is tender if normal activities become very painful and the pain doesn’t get better with medicine.
• Narcotics like hydrocodone/acetaminophen (Norco, Vicodin) or oxycodone/acetaminophen (Percocet, Roxicet, Tylox) can help with extreme pain, but, as with any narcotics, there’s danger of becoming addicted to them.
• Steroids. Your doctor can give you a corticosteroid shot directly into a painful joint, but that’s considered something of a last resort.
• Tricyclic antidepressants or cyclic antidepressants like amitriptyline can help ease pain, but they also can have side effects, like weight gain and drowsiness. 
• Antiseizure drugs, usually gabapentin (Neurontin), are typically used to treat epilepsy, but they also may help with costochondritis.
• Infectious (bacterial or fungal) costochondritis should be treated with IV antibiotics. Afterward, antibiotics by mouth or by IV should be continued for another 2 to 3 weeks. You should see a doctor during recovery, and then once a year. 

Surgery for Costochondritis

You may need surgery to remove the sore cartilage if other treatments don’t help. Your doctor can refer you to a surgeon.

Because inflammatory costochondritis has no definite cause, there is no good way to prevent it.

Noninfectious costochondritis will go away on its own, with or without anti-inflammatory treatment. Most people will recover fully.

Infectious costochondritis responds well to IV antibiotics and surgery, but recovery may take a long time.

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Pleurisy – Better Health Channel

Summary

Read the full fact sheet

• The pleura are the thin membranes that line the inner wall of the chest and form the outside covering around the lungs.
• Pleurisy is a condition whereby inflammation of the pleura causes the membranes to rub and grate against each other.
• Common causes of pleurisy include bacterial and viral infections which can lead to pneumonia.
• Other causes of pleurisy include a pulmonary embolus, cancer and trauma to the chest wall.
• Some causes of chest pain are dangerous and potentially life-threatening, so it is important to ask your doctor to assess any chest pain that worries you.

Each of your lungs is covered by a thin membrane called the visceral pleura. The inner wall of your chest is lined by a similar thin membrane called the parietal pleura. In healthy people, the visceral and parietal pleura are separated by a thin layer of fluid. This fluid allows the lungs to slide across one another other easily as the lungs expand and contract during breathing.

Pleurisy is a condition whereby inflammation of the pleura leads to a loss of the smooth sliding movement between the pleura. This is commonly caused by an infection of the respiratory tract.

Inflammation of the pleura causes pain, which is made worse by deep breathing and coughing. Sometimes, the inflammation can cause a build-up of the fluid between the two membranes. This is known as a pleural effusion.

Treatment options for pleurisy include addressing the underlying cause and taking medications such as anti-inflammatory medications, antibiotics and pain medications.

Symptoms of pleurisy

The symptoms of pleurisy may include:

• pain in the chest, which may be:
  • sharp or stabbing in nature
  • aggravated by taking a deep breath in, coughing or moving around
  • felt in the muscles of the chest
• persistent cough
• breathing difficulties
• generally feeling unwell
• fever.

Your risk of getting pleurisy is higher if you have recently had an infection of the respiratory tract.

Causes of pleurisy

Causes of pleurisy include:

• viral infection
• bacterial infection
• pneumonia (an infection of the lungs)
• tuberculosis
• trauma to the chest wall
• connective tissue disorders such as rheumatoid arthritis and lupus erythematosus
• pulmonary embolus (blood clot)
• cancer.

Pleural effusion and pleurisy

In a person with pleurisy, inflammation can trigger a build-up of fluid between the two membranes. This fluid build up is referred to as a pleural effusion. This can be caused by an overproduction of fluid by one membrane or by the failure of the other membrane to drain the fluid properly.

Pleural effusion may ease the symptoms of pleurisy, since the fluid stops the membranes from grating against each other. However, the build up of fluid around the lungs can cause compression of the lungs and can lead to breathing difficulties, such as shortness of breath or rapid breathing. The lack of oxygen may turn areas such as the mouth and fingertips blue (cyanosis).

Apart from pleurisy, other causes of a pleural effusion include cancer, protein deficiencies and some types of heart disease.

Diagnosis of pleurisy

Diagnosing pleurisy involves a number of tests, including:

• physical examination – using a stethoscope, the doctor can hear the pleura rubbing against each other. Other breath-sound abnormalities that suggest pleurisy include rattling or crackling
• blood tests – to determine whether the cause is viral or bacterial
• chest x-rays and other imaging – including CT scans or ultrasound scans
• thoracocentesis – doctors remove and examine a small sample of pleural fluid
• bronchoscopy – doctors insert a thin tube with a camera into the person’s windpipe to examine the airways.

Treatment for pleurisy

Treatment for pleurisy may include:

• treating the underlying cause – for example, treatment for tuberculosis
• anti-inflammatory medications
• other medications to manage the pain
• antibiotics for a bacterial infection
• draining off the excess fluid – in the case of a pleural effusion
• medications to stop the fluid from building up again.

Prevention of pleurisy

Bacterial pleurisy is often caused by pneumonia which is an infection of the lungs. The infection of the airways and lungs can then spread to include the pleura.

There is a vaccine against one of the most common organisms that causes pneumonia. It is recommended that people who are at risk of pneumonia be immunised, including young children, older people over the age of 65, people with chronic medical conditions (such as diabetes) and people with reduced immunity.

Apart from vaccination, treating any infection of the respiratory tract promptly can also reduce the risk of developing pleurisy.

Where to get help

• Your GP (doctor)
• NURSE-ON-CALL Tel. 1300 60 60 24 – for expert health information and advice (24 hours, 7 days)
• Lung Foundation AustraliaExternal Link Tel 1800 654 301

This page has been produced in consultation with and approved
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Chest pain | LRC. Treatment and Rehabilitation Center of the Ministry of Economic Development of Russia

Chest pain is one of the most common complaints made by patients when they visit a doctor. There are many reasons leading to this problem. We will only talk about the most common of them.

Causes

To make it easier to understand the causes of chest pain, let’s break them into four main groups:

• Respiratory diseases
• Musculoskeletal diseases
• Diseases of the heart and large vessels
• Diseases of the digestive system

Look at how many different specialists a person with complaints of chest pain should see to identify its cause: pulmonologist, cardiologist, neurologist and ha stroenterologist . Therefore, it would seem to me more reasonable and correct, when this complaint appears, to first turn to a competent therapist, so that he can figure out which organ system is the cause of the pain, and then advise which specialist to contact.

Since I am a pulmonologist, I will try to answer the question:

When do chest pains occur in bronchopulmonary diseases?

Why the lungs “do not hurt”

There are no pain receptors in the lung tissue, so pain in diseases of the bronchopulmonary system occurs only if the sheets covering the lungs – the pleura – are affected. No wonder the pain in these diseases is called “pleural pain.”

Another cause of chest pain in bronchopulmonary diseases can be tracheobronchitis.

Mechanism of “pleural pains”

In a healthy state, during breathing, two layers of the pleura (one covers the lung, the other lines the chest wall from the inside) slide over each other’s surfaces, which allows the lungs to collapse and straighten out freely and painlessly during breathing. When these sheets become inflamed or growths appear on them, during breathing, they rub against each other due to the resulting “irregularities” (roughness). As a result, pain with deep breathing and coughing.

Causes of “pleural pain”

• The first and most common cause of “pleural pain” is inflammation of the pleura itself and/or the lung covered by it. No wonder some types of pneumonia are called pleuropneumonia, that is, inflammation of the lungs and pleura.
• Tumor diseases of the pleura and lungs can also become the cause of “pleural pain”.
• Pneumothorax (air entering the pleural space) can also cause pain.

Features of “pleural pain”

“Pleural pain” is most often unilateral, acute, aggravated by deep inspiration and coughing. The pain is sometimes so severe that it forces the person to take only shallow breaths.

The person takes the so-called “forced position”, that is, he tries not to breathe on the side of the chest where the source of pain is located. To do this, he lies down on the affected side or presses it with his hands, thus limiting the mobility of the chest.

Please note that in some cases, when fluid begins to accumulate between the layers of the pleura, pushing its layers apart and not allowing them to “rub” against each other, the pain in the chest decreases, but shortness of breath appears.

What to do?

First of all, consult a doctor. The doctor can hear the rubbing noise of the pleura, make an x-ray of the chest, ultrasound of the pleural cavity, CT of the chest to assess the damage to the lungs and pleura.

Therapy will be prescribed depending on the cause of the pleural pain.

Tracheobronchitis is another cause of chest pain associated with bronchopulmonary pathology.

Inflammation or swelling of the trachea and large bronchi may cause discomfort behind the sternum, which is aching or raw. They occur mainly when air is inhaled, especially cold air, worse when lying down, often accompanied by a strong cough.

If these pains occurred due to a cold, then most likely it is inflammation of the trachea – tracheitis. Against the background of the anti-inflammatory therapy prescribed by the doctor, these pains, along with the cough, quickly disappear.

If the pain persists and there was no apparent reason for their appearance, then to clarify the diagnosis, the doctor may prescribe a computed tomography of the chest organs, and, if necessary, a bronchoscopy.

full description, symptoms and causes

This disease is most often a manifestation of acute respiratory viral infections (ARVI). Bacterial acute bronchitis is rare.

The incidence of this pathology in Russia is 75–250 cases per thousand children per year. Most often, children under 6 years of age are sick. In most cases, acute bronchitis is mild and self-limiting. Treatment is usually limited to symptomatic and supportive therapy.

Reasons

The most common causative agents of acute bronchitis in children are viruses that cause SARS. They are responsible for approximately 90% of cases . Rhinoviruses and respiratory syncytial virus are especially common. Also found:

• parainfluenza viruses
• coronaviruses, including novel SARS-CoV-2
• metapneumaviruses
• bocaviruses
• adenoviruses
• influenza viruses
• Coxsackie viruses
• herpes simplex viruses

Bacterial infections account for the remaining 10% of cases . They can be caused by microorganisms such as:

• Streptococcus pneumoniae
• Moraxella catarrhalis
• Haemophilus influenzae
• Chlamydia pneumoniae
• mycoplasmas (mycoplasma species)

There are other causes of the development of acute bronchitis in children:

• Secondhand smoke – when the child is regularly exposed to tobacco smoke
• Air pollution, stay in smoky, dusty rooms
• Allergic reactions
• Genetic features. There is such a thing as single nucleotide polymorphisms (SNPs). These are variants of genes that are considered normal, but some of them can increase the susceptibility to the development of certain diseases. Scientific studies have shown that certain SNPs increase the risk of developing bronchitis in the presence of airborne pollutants.
• Aspiration – a condition in which the contents of the digestive tract enter the respiratory tract
• Gastroesophageal reflux is a condition in which stomach contents back up into the esophagus and may enter the respiratory tract.
• Fungal infection

The development of the disease is facilitated by frequent hypothermia and SARS, chronic foci of infection in the upper respiratory tract, immunodeficiency states, respiratory failure through the nose (for example, due to adenoids). As in the case of SARS, the prevalence of acute bronchitis increases in the cold season.

Pathogenesis

When a pathogenic virus enters the bronchi, it causes inflammation. There is swelling of the mucous membrane, goblet cells produce a lot of mucus. Different types of leukocytes migrate into the bronchial wall, they produce inflammatory molecules – cytokines. Inflammation leads to contraction of muscle fibers in the wall of the bronchi – bronchospasm. As a result of all these processes, the patency of the airways is impaired.

Normally, a protective mechanism works in the bronchi, which is called mucociliary clearance. Special goblet cells in the mucous membrane produce mucus in which bacteria, viruses, and other pathogens “get stuck”. Other cells – ciliated – make movements with their cilia and bring mucus along with pathogens to the outside. In acute bronchitis, the work of this system is disrupted, which leads to stagnation of mucus. There are favorable conditions for the reproduction of pathogens.

After some time, adaptive immunity is connected to nonspecific defense mechanisms. Immune cells “recognize” the pathogen and begin to produce antibodies against it, destroy it and the affected cells. Recovery comes gradually.

Classification

To begin with, consider the general classification of bronchitis depending on the duration of the course:

• Acute bronchitis – when the illness lasts less than 20-30 days. Its symptoms strongly resemble those of the flu and other acute respiratory viral infections, which is why English-speaking doctors often call it the “chest cold” (chest cold).
• Recurrent bronchitis is diagnosed when there are repeated episodes 2-3 times a year against the background of SARS.
• Chronic bronchitis is characterized by at least two to three exacerbations per year for two years.

Classification of acute bronchitis in children depending on the causes :

• Infectious . It is divided into viral (occurs in most cases), bacterial (much less often) and fungal (extremely rare).
• Non-infectious – due to other causes (tobacco smoke, air pollution, allergies, etc. )

Depending on the caliber of the affected bronchi , bronchitis can be:

• Proximal – in the largest bronchi closest to the trachea.
• Distal – in the bronchi of smaller diameter, located below.
• Bronchiolitis – in the smallest bronchi (bronchioles).

Classification according to clinical picture :

• Acute obstructive bronchitis in children – accompanied by narrowing of the bronchi, causing difficulty and rapid breathing, shortness of breath.
• Non-obstructive – does not cause respiratory failure and is more mild.

Depending on the nature of inflammation :

• Catarrhal – occurs in the vast majority of cases and is characteristic of viral infections. Sputum is clear mucus.
• Purulent – more characteristic of bacterial infections. There is pus in the sputum, because of this it is more viscous, has a yellow-green color.

Symptoms

The disease begins acutely. Symptoms of acute bronchitis in children usually resemble SARS. In the first days, there is an increase in body temperature, malaise, muscle pain, headache, sore throat may be disturbing.

From the second or third day of illness, a cough appears. At first it is dry, it can be sharp, hoarse, and then it weakens and becomes productive: sputum is released during it. However, children under 5 years of age rarely expectorate it well. Their sputum often comes out with vomit during the so-called post-cough vomiting.

Cough is usually accompanied by runny nose and nasal discharge. In the first days they are watery and transparent, then they can become opaque, yellow-green, and after a while they again acquire a mucous-watery consistency. When nasal discharge becomes purulent, many parents begin to panic, but in general, this picture is typical for viral infections and does not in itself indicate that pathogenic bacteria have joined.

With bronchial obstruction, the following symptoms occur:

• wheezing – parents can hear them when they are near the child
• expiratory extension
• rapid breathing
• unproductive cough – during which practically no sputum comes out
• child anxiety
• the child tries to find a position in which it will be easier for him to breathe

In severe cases, there is a burning sensation and discomfort in the chest, severe shortness of breath, hemoptysis (streaks of blood in the sputum).

The symptoms listed above are typical of an infection caused by viruses. They go away on their own within a week.

For acute bronchitis, caused by bacteria and, some features of the clinical picture are characteristic:

Diagnostic methods

For the most part, the diagnosis of acute bronchitis in children is based on the results of the examination. Additional research is practically not required. Diagnosis and treatment of the disease are carried out by pediatricians . During the appointment, the doctor collects an anamnesis, asks about symptoms, examines the child, listens to his chest with a phonendoscope, measures body temperature, evaluates heart rate and respiratory movements. In acute viral bronchitis, scattered wet and dry rales are heard during auscultation of the lungs.

General blood and urine tests are always prescribed, just in case, so as not to miss pneumonia and bacterial infections. In acute viral bronchitis, changes in the general blood test are insignificant and say little. The level of leukocytes usually does not increase more than 15×109/ l.

If the clinical picture is beyond doubt, then it makes no sense to look for the pathogen using virological and bacteriological studies. Even if there is an assumption that the disease is caused by mycoplasmas, laboratory confirmation of this fact will give little: PCR results are positive not only in patients, but also in carriers, IgM class antibodies can be detected only by the end of the second week of illness, and an increase in the level of IgG class antibodies is noted after a previous infection.

But if you suspect an infection caused by C. trachomatis, it makes sense to determine the titer of IgM antibodies. If influenza is suspected, laboratory diagnostics are also indicated – PCR swabs from the nose and throat, serological tests (determination of antibodies in the blood).

Chest x-ray is not needed in most cases because it shows little in bronchitis. The doctor can prescribe images only in certain cases:

• If pneumonia is suspected:

1. during auscultation of the lungs, breathing is weakened, small and medium bubbling rales are heard on inspiration, a characteristic sound is possible – crepitus
2. temperature above 38°C persists for more than three days
3. dyspnoea accompanied by indrawing of pliable places on the chest wall
4. significant increase in respiratory rate

• If a foreign body is suspected in the respiratory tract.
• With persistent “metallic” cough. It may indicate a pathological process in the mediastinum – tissues located between the lungs.

With obstructive syndrome and severe shortness of breath , pulse oximetry (assessment of blood oxygen saturation), spirometry (examination of the function of external respiration) can be performed.

Many parents perceive the diagnosis of bronchitis as a more “severe” form of a cold (“the infection has descended into the bronchi!”) And something that goes from half a step to pneumonia.

This causes panic and the desire to urgently “save” the child. Some demand that the pediatrician immediately conduct not just an X-ray, but a CT scan – so as not to miss anything for sure. A doctor faced with such anxious parents has two choices. You can create an imitation of violent activity and prescribe as many tests, studies as possible, and then issue a long list of drugs. All this will calm mom and dad, cause laudatory reviews about the doctor, but will bring unnecessary stress to the child. The second option: act strictly within the framework of evidence-based medicine, and oppose parental fears with detailed explanations with links to reliable sources, mention scientific research. This is how doctors work at the Nashe Vremya clinic. We act solely in the interests of the child and prescribe only those studies, those methods of treatment that are objectively necessary at the moment and will be beneficial.

What diseases should be differentiated?

Some pathologies are manifested by symptoms resembling those of acute bronchitis:

• Bronchial asthma . This is where confusion occurs most often. According to some reports, doctors mistakenly diagnose bronchitis instead of asthma in about a third of children with acute cough
• Acute sinusitis – inflammation of the paranasal sinuses
• Gastroesophageal reflux disease (GERD) is a condition in which stomach contents back up into the esophagus. It is not only a risk factor for developing bronchitis, but can also be accompanied by similar symptoms
• Viral pharyngitis

Methods of treatment

First of all, it is worth talking about how acute bronchitis should not be treated , and dispel common myths about some common methods.

Since Soviet times, all kinds of thermal procedures have been popular in the form of warming patches, mustard plasters, cans, compresses, and hot steam inhalations. In fact, the benefits of such techniques are doubtful, and they can cause considerable harm – for example, in the form of burns or generalization of infection. Not to mention the fact that such procedures often cause severe stress to children.

Antibiotics for acute viral bronchitis are useless. Their use only contributes to the emergence of resistant bacteria – they have already become a big problem for modern healthcare. The next time antibiotics are actually needed, they may not be effective.

There are no antiviral drugs with proven efficacy for the treatment of SARS.

The only exception is influenza. With a confirmed diagnosis in children, amantadine, oseltamivir, zanamivir, peramivir and baloxavir – are used strictly according to the doctor’s prescription!

Antihistamine (antiallergic) drugs do not have proven efficacy in this disease. They can only do harm: against the background of their intake, the discharge in the bronchi “dries up”, and because of this, the cough intensifies.

For viral infections treatment is symptomatic :

• Plentiful warm drink
• If the temperature is more than 38 ° C and the child feels unwell – drugs from the group of non-steroidal anti-inflammatory drugs (NSAIDs). Paracetamol (acetaminophen) and ibuprofen are used in children. Aspirin should not be given to a child.
• If the sputum is thick and difficult to expectorate, expectorants and mucolytics (sputum thinners) according to the age of the child.
• For dry, painful, agonizing cough, a short course of antitussives may be indicated.
• For bronchial obstruction – bronchodilators (drugs that widen the lumen of the bronchi): beta 2-agonists or combined drugs.
• A humidifier can be installed in the child’s room.

Usually in children, the disease proceeds in a mild form, and hospitalization is not required – treatment is carried out on an outpatient basis, at home.

If it is established that the inflammation in the bronchi is caused by mycoplasmas or chlamydia, antibiotics from the macrolide group may be prescribed. Moreover, laboratory confirmation is not always necessary: ​​if the symptoms are typical for a mycoplasmal infection, then the doctor will most likely immediately prescribe antibiotic therapy. The child usually gets better within 1 to 2 days of starting treatment. For other diagnosed bacterial infections, drugs are selected that are sensitive to the microorganisms that caused them.

If the doctor has prescribed antibiotics, it is important to take them strictly on time, in accordance with the prescriptions. Self-medication is unacceptable.

Possible complications

In rare cases, acute bronchitis in a child leads to complications:

• Purulent bronchitis – if a bacterial infection is added to a viral infection.
• Pneumonia – inflammation of the lungs.
• Long current , the transition of the disease to a chronic form.
• In turn, long-term bronchitis leads to changes in the mucous membrane of the respiratory tract , which create prerequisites for the development of bronchial asthma, chronic obstructive pulmonary disease (COPD) in adulthood.
• Respiratory failure and apnea . The risk of developing these conditions is highest in premature babies in the first two months of life.

Forecast

In most cases, acute bronchitis in children is a self-limited disease. It goes away on its own, usually within a week. The course can be delayed if the child has chronic foci of infection in the upper respiratory tract, an immunodeficiency state, and serious concomitant diseases.

Prophylaxis

Specific prevention of acute bronchitis in children is provided only against certain pathogens. Every year, the entire population, including children, is recommended to be vaccinated against influenza – this is reflected in the National Calendar of Preventive Immunizations in Russia. There are vaccines against the SARS-CoV-2 coronavirus for adolescents, for example, the domestic drug Gam-COVID-Vak-M (from 12 to 17 years old inclusive).

Other preventive measures include:

• Avoidance of crowded places during seasonal influenza and SARS epidemics.
• Timely treatment of chronic foci of ENT infections.
• Thorough handwashing with soap after visiting the street and public places – at least 20 seconds.
• Avoid contact with sick people.
• Wearing a mask in public places during the epidemic season.
• If there is a patient with SARS or flu at home, then it is necessary to allocate a separate room for him, regularly carry out wet cleaning and ventilation, and do not use common utensils and other items.

Main

• Acute bronchitis is a clinical syndrome characterized by inflammation of the bronchial mucosa.
• Most often, the disease is of a viral nature and develops as a manifestation of SARS.
• Manifestations of the disease resemble those of SARS. Body temperature rises, nasal congestion, cough.
• Diagnosis is mainly based on the results of a child’s examination by a doctor. Instrumental and laboratory diagnostic methods are carried out according to indications. The doctor may order general blood and urine tests, chest x-rays, and other diagnostic procedures.
• Treatment of viral bronchitis is symptomatic. Banks, mustard plasters, hot inhalations, antihistamines have no proven effectiveness.
• The prognosis is usually good. Most often, the disease occurs in children in a mild form and disappears after a few days.
• Pneumonia and other complications are rare.

sources:

Gerardo Sison, Pharm.D. Bronchitis Treatments and Medications.
medical news today. Is bronchitis contagious?
https://www.invitro.ru/moscow/library/bolezni/26150/
https://zdorovie-vn.ru/stati/obstruktivnyij-bronxit-u-detej
Rakesh Ghosh, Jan Topinka, Jesse Joad et al. Air pollutants, genes and EARLY childhood Acute bronchitis. Mutation Research/Fundamental and Molecular Mechanisms of Mutagenesis. DOI:10.1016/j.mrfmmm.2013.04.001.
stanfordchildren.org.
Douglas M Fleming, Alex J Elliot. The management of acute bronchitis in children. Expert Opin Pharmacother. 2007 Mar;8(4):415-26. doi: 10.1517/14656566.8.4.415.
Anumeha Singh; Akshay Avula; Elise Zahn. Acute Bronchitis. Treasure Island (FL): StatPearls Publishing; 2022 Jan-.
https://www.cincinnatichildrens.org/health/a/acute-bronchitis.
https://emedicine.medscape.com/article/1001332-overview
urmc.rochester.edu.
https://fantasyclinic.ru/services/treatment/pediatriya/ostryy-bronkhit-u-detey/.
Zaitsev A.A. ACUTE BRONCHITIS: CLINICAL RECOMMENDATIONS // MS. 2020. No. 17.
Union of Pediatricians of Russia. Acute bronchitis in children. Clinical guidelines.

Rakesh Ghosh, Pavel Rossner, Katerina Honkova, Miroslav Dostal, Radim J Sram, Irva Hertz-Picciotto.