Upper respiratory tract edema in the child

Edema of the mucous membrane of the upper respiratory tract. How to deal with it

nasal mucosa inflammation

In ordinary practice, in everyday life, rhinitis -Inflammation of the nasal mucosa is often called a runny nose. Despite the obvious similarity or even synonymity of these terms, they still have a difference: if the term "rhinitis" determines the inflammation of the nasal mucosa (that is, the mechanism of the development of the disease), the term "runny nose" more determines the symptoms of inflammation (in this case we are talking about phase of exudation, accompanied by the appearance of serous discharge).

Rhinitis is rarely an independent disease. Most common cold is a symptom of some other nosological form. Runny nose is observed with various ARVI or ARI (influenza, parainfluenza, adenovirus infection, measles, etc.). Acute respiratory diseases are the most common in the structure of infectious diseases. In Russia, about 50 million cases of infectious diseases are registered each year, of which up to 90% of cases occur in acute respiratory viral infections. In the pathology of ENT organs, the mucosa with its glandular cells first of all suffers. The main etiological factors in the development of inflammation of the mucosa of the ENT organs are viral and bacterial infection. The mucosa of the respiratory tract is a very favorable environment for the development of a wide variety of microorganisms: bacteria, viruses and fungi. Therefore, infectious diseases are the most frequent diseases in the pathology of ENT organs. At a time when the defenses of the body are weakened, due to hypothermia, the effects of cold and moisture, drafts, and also due to the presence of pathogenicity factors, virulent microorganisms penetrating the mucous membrane cause edema, as well as an increase in secretion of the mucous glands and desquamation of the epithelium. The most common rhinitis is observed during periods of sharp temperature fluctuations, which is associated with a change in virulence (the degree of pathogenicity) of microorganisms, as well as with a supercooling factor. A particularly pronounced reaction of the mucous membrane of the nasal cavity is observed when the feet are cooled. This is due to the presence of reflexogenic connections between the feet and the nasal mucosa.

As a result, naturalanastomoses of the paranasal sinuses with a swollen mucous membrane and a pathological secret. In this case, the emerging block of anastomosis makes it difficult to transport the secret from the sinuses. A similar situation develops in the lesion of the mucous membrane of the nasopharynx, leading to the blockage of the pharyngeal openings of the auditory tube. Stagnation of secretion, violation of ventilation and associated hypoxia are the starting point for activating the saprophytic flora. Thus, the initial viral infection is replaced by a bacterial infection, and the primary bacterial pathology can be complicated by the association of the associative flora, which will lead to an increase in the course of the disease.

Such frequent diseases of the respiratory tractare explained by a variety of etiological factors (influenza viruses, parainfluenza, adenoviruses, rhinoviruses, reoviruses, respiratory syncytial virus), as well as ease of transmission of the pathogen from one person to another. In addition to viruses, the defeat of the upper respiratory tract can be caused by bacterial agents, as well as intracellular pathogens - mycoplasmas, chlamydia and legionella. Despite the progress in the treatment of various diseases, etiotropic therapy of viral pathology remains insufficiently developed. In connection with this, the timely use of symptomatic and pathogenetic means aimed at suppressing the mechanisms of development of clinical manifestations and alleviating the symptoms of the disease is of decisive importance in the treatment of ARVI. Pathogens ARVI have tropism to the mucosa of the upper respiratory tract. When they penetrate the epithelial cells, a local inflammatory reaction develops. Absorption into the systemic bloodstream of cell decay products leads to systemic toxic manifestations. The result is a typical symptomatic complex for ARVI: a combination of local (rhinitis, cough, nasal congestion, pain or swelling in the throat, change in the voice tone) and general toxicity (headache, weakness, lethargy, fever, muscle pain) reactions.

Infectious rhinitis is the mosta common symptom of various infections (infectious diseases) that occur with the defeat of the upper respiratory tract. Moreover, in addition to the most common cold, the patient also complains of other symptoms characteristic of this or that disease. Often at the same time as a cold there is a headache, body temperature rises, there is a feeling of fatigue and weakness. The development of infectious rhinitis is determined by the direct aggressive action of pathogenic microbes (bacteria or viruses) on the nasal mucosa. As mentioned above, the nasal mucosa is the first barrier to the protection of the respiratory tract, therefore hundreds or even thousands of microbes are precipitated on the nasal mucosa every second. Most of these microorganisms are representatives of saprophyte microflora and do no harm to humans, while others are capable of provoking the development of an infectious disease (pathogenic, pathogenic microbes). With infectious rhinitis, the multiplication of microbes on the nasal mucosa leads to its damage and exfoliation of the upper part of the epithelium. This process explains all the manifestations of the common cold: a burning sensation in the nose, mucus effusion, nasal congestion, voice changes (nasal), etc. It should be noted that the mucus outflow from the nasal cavity in the rhinitis is caused by the reaction of the blood vessels and the epithelium of the nasal mucosa inflammation. Sputum discharge from the nose is the main defense mechanism in the common cold: with pathogenic germs, pathogenic microbes are excreted from the body.

At the same time, the main phases clearly changeinflammatory process. So, getting with inhaled air on the mucous membrane of the nose, the viruses penetrate into the surface cells that have cilia, and there develop within 1-3 days. Normally, the cilia make oscillatory movements, as a result of which the nose is purged from foreign agents, which protects the body against possible adhesion and invasion of microorganisms. Viruses, getting on the mucous membrane of the upper respiratory tract and reproducing in its cells, causing alteration, sharply violate its integrity. Reproduction of viruses is accompanied by a cytopathic effect, the degree of which is determined by the features of the pathogen. In the mucous membrane of the respiratory tract, inflammation develops, accompanied by a sharp vasodilation with an increase in the permeability of the vascular wall and increased exudation. The phenomena of acidosis increase, conditions are created for attaching a secondary bacterial infection, which is the cause of complications of acute rhinitis. Moreover, in addition to the nasal mucosa, the mucous membrane of the paranasal sinuses, as well as the middle ear, can be affected.

The first stage (dry irritation) developsquickly, lasts from a few hours to 2 days. Mucous membrane sharply pale at the expense of narrowing of vessels, dryness, burning in the nasal cavity, multiple sneezing. After this comes the second stage - serous discharge, which is characterized by the release of a transudative fluid rich in mediators of inflammatory reactions, which lasts on average from 2 to 3 days. In acute inflammation, exudative processes predominate. Initially, in the early stages of inflammation, serous exudate, then mucoid-serous. This increases the permeability of capillaries and develops mucosal edema; there is a sharp vasodilation, reddening of the mucosa and edema of the nasal concha. Difficult nasal breathing is noted, with viral infection abundant transparent watery discharge from the nose, decreased sense of smell, lacrimation, stuffiness of the ears and nasal hue of the voice. The nasal mucosa has a bright red color. The beginning of the third stage is due to the release of the formed blood elements into the inflammatory focus and corresponds to the stage of proliferation of the inflammatory reaction. Most often, the third stage is characterized by the attachment of bacterial pathogens, which normally grow on the mucous membrane of the upper respiratory tract, forming the so-called transient microflora. With the addition of a bacterial infection, the discharge from the nose becomes purulent, containing a large number of leukocytes and detritus. The general condition of patients, as a rule, while improving, nasal breathing and sense of smell are gradually restored, but the discharge from the nose acquires a yellow or green color and a more dense consistency. The color of the nasal mucosa gradually approaches normal, and the lumen of the nasal passages gradually widens.

The whole cycle of the disease is completed in 7-10 days. Individual stages may be more or less pronounced or completely absent if there is no viral or bacterial infection. In some cases, with good immunity and fast-initiated treatment, recovery is possible within 2-3 days; with a weakened state of the body's defenses and inadequate treatment, rhinitis can last up to 3-4 weeks, go into a chronic form or lead to complications.

In addition to infectious diseases, industriallyDeveloped countries currently between 10 and 20% of the population suffer from acute allergic diseases. Since the entire body is a single whole, in the case of damage to the mucosa of one organ, the process can easily spread to other organs and tissues. Observing the manifestation of pathology in a separate organ or system, it is necessary to constantly remember the possibility of the spread of the process and the development of various local and general complications. In addition, in the pathogenesis of inflammatory diseases of the upper respiratory tract, along with the local and general action of the pathogen, the role of sensitization of the organism and immunological shifts directly in the mucous membrane of the nose and paranasal sinuses play a role.

Nasal mucosa is the area thatis exposed to a wide variety of foreign particles. Molecules of allergens extremely quickly cause an allergic reaction, which causes a sneeze, itching in the nasal cavity, rhinorrhea within a minute after the penetration of allergens. With allergic rhinitis, the developing reactions refer to immediate reactions. Their mechanism consists in a sequence of successive stages. The reaction is triggered by the interaction of the allergen with allergic antibodies related to IgE. The interaction of the allergen with IgE occurs on mast cells of connective tissue and basophils. Then follows the release of biochemical mediators from mast cells and basophils. Histamine is the most important substance that is released from the mediator cells in the allergic pathology of the nose. He has a variety of actions. First, direct action on cellular histamine receptors, which is the main cause of edema and nasal congestion. Secondly, histamine has an indirect reflex action, which leads to sneezing. Thirdly, histamine causes an increase in the permeability of the epithelium and hypersecretion. All these factors together lead to pronounced edema of the mucous membrane and blockage of the sinuses of the sinuses of the nose and auditory tube. There are the necessary prerequisites for the development of an already infectious pathological process in the ENT organs.

As other etiological factorsExposure to the mucous membrane can also be exhaust gases, chemical and dust irritants, tobacco smoking, unfavorable meteorological conditions. Tender epithelial tissue is most susceptible to adverse environmental factors. In the city, directly at the surface of the earth, the greatest concentration of all kinds of xenobiotics is found-free radicals, carcinogens, heavy metal salts, all kinds of allergens, and, of course, pathogenic microorganisms. The mucous membrane of the nose, oral cavity and pharynx is in constant contact with the inhaled air and thus is exposed to harmful environmental factors, which leads to its edema. In any case, there are conditions in which the nasal mucosa easily becomes infected, reacting with the appearance of a significant edema.

In the treatment of acute rhinitis, the main role is played bynasal decongestants. Nasal decongestants (from congestion) are a group of drugs that cause vasoconstriction of the vessels of the mucous membrane of the nasal cavity. Being a-adrenomimetics, nasal decongestants cause stimulation of adrenergic receptors of the smooth muscles of the vascular wall with the development of reversible spasm. The regulation of nasal resistance is provided by the autonomic innervation of the anatomical structures of the nasal cavity. Depending on the parameters of the inhaled air (temperature, humidity), the vegetative mechanisms regulate the blood filling of the mucous membrane of the nasal cavity and the cavernous bodies of the nasal concha, as well as the quantity and physico-chemical properties of the secreted mucus. So, it is known that parasympathetic stimulation causes vasodilation and an increase in blood filling of the mucous membrane, with an increase in the amount and a decrease in the viscosity of mucus. And, conversely, with sympathetic stimulation, vasoconstriction develops and blood clotting of the mucous membrane decreases.

Despite the difference in pathogenetic mechanismsmentioned phenomena, common for them is symptomatic therapy with nasal decongestants. Nasal decongestants quickly and effectively eliminate symptoms of nasal congestion and rhinorrhea, which determines their high popularity among the population. Most decongestants are sold in the departments of OTC, and many patients use them independently, without consulting a doctor. This is the reason for the large number of complications and prejudice of specialists to this group of drugs. It is important to remember that most vasoconstrictors are not recommended for long courses, more than 7 consecutive days. Do not exceed the dose specified in the annotation, especially for drugs in the form of nasal drops, difficult to dosage.

Currently, in the domestic market of drugsthis group of drugs is presented very widely, and it is often difficult for patients to make a choice between them. One such medication is the well-known and well-proven topical vasoconstrictor Otrivin, which differs in its properties from other a-adrenomimetics. Otrivin is a dosage form of xylometazoline with moisturizing ingredients.

Otrivine contains sorbitol, which is used inpharmaceutics and cosmetics and has the properties of a moisturizer, normalizing the level of liquid in the mucous membrane, while avoiding drying and irritation and providing a softening effect on the mucosa, as well as methyl hydroxypropylcellulose, which increases the moisturizing effect by increasing the viscosity of the solution.

The advantage of Otrivin is highefficiency, which allows you to actively remove nasal congestion due to the narrowing of the blood vessels of the mucosa, without irritating it and without interfering with the function of the ciliary epithelium of the nasopharynx. It has a prolonged (up to 12 hours) action, and it can be used up to 2 weeks with a chronic or prolonged runny nose. Thus, the drug has a unique prolonged vasoconstrictor effect.

Recently, on the drugstore counters appeareda fundamentally new drug - Otrivin More, the main advantage of which is its composition itself. The agent is an isotonic solution consisting of oceanic water from Brittany, extracted in an ecologically clean area of ​​the Atlantic Ocean, enriched with natural microelements and minerals, which ensures the most gentle and physiological care of the nasal cavity. Due to this composition, Otrivin More is ideally suited to protect the nasal mucosa from unfavorable conditions of the city, and also to facilitate nasal breathing during illness. Otryvin More provides quick elimination of pathogens and allergens, that is, many times reduces their concentration and promotes mechanical cleaning of the surface of the nasal mucosa. In addition, Otrivin More stimulates cells of the ciliated epithelium, promotes the normalization of mucus production and liquefaction, and also increases local immunity. An important advantage of the drug is the absence of any systemic action on the patient's body, which is extremely important for people suffering from various physical diseases and who are afraid of taking traditional topical vasoconstrictors because of the risk of side effects. In addition, the patient is able to reduce the dosage of other drugs used for complex treatment, and accelerate recovery.

Otrivin More can be used both inpreventive and curative purposes, and for daily hygiene of the nasal cavity. Novelty does not contain preservatives and additional chemical ingredients. The main indications for prescribing the drug are acute rhinitis (including allergic) and nasal congestion. With a cold and allergies, Otrivin Moree facilitates breathing, delicately mechanically cleansing the nasal passages, and also exerts a certain antibacterial effect. In addition, the agent can be used for hygiene of the nasal cavity before the use of other medicaments. For the prevention of the use of the drug Otrivin More in the period of epidemics of various viral diseases, preventing the development of various forms of the infectious process on the nasal mucosa. The drug can also be used for the hygiene of the nasal cavity, effectively cleaning the nasal mucosa and moisturizing it gently.

It's no secret that many nasal preparationscause uncomfortable sensations when they are taken, which is associated with irritation of the mucous membrane of the nasal cavity. Otrivin More is devoid of this side effect. Rinsing the nasal cavity, the drug removes dust, bacteria and secret and prevents its drying, thus protecting the external factors from the irritating effect, which is especially important for people working in rooms with excessively dry air (for example, where air conditioners are installed or near heating appliances) which is not by hearsay familiar unpleasant sensation in the nasal cavity.

Of great importance is the form of release of the drug. When using nasal drops, most of the injected solution flows down the bottom of the nasal cavity into the pharynx. In this case, the necessary therapeutic effect is not achieved. In this regard, the appointment of metered aerosols looks much more beneficial. A unique feature of the drug Otrivin More is release in the form of a nasal spray, equipped with a unique anatomical tip. The curved shape of the nozzle allows you to evenly and accurately irrigate the nasal mucosa and reach even its most difficult areas. Thanks to this design, the product moistens the nasal cavity and thoroughly cleans it, ensuring comfortable breathing throughout the day. The advantages of the spray include even irrigation of the nasal mucosa, the ability to reach the uppermost areas of the nasal cavity, and economy.

All of the above suggests thatthe drug Otrivin More is a reliable agent that cleans the nasal mucosa in adults and children, restoring its physiological function without causing its dryness and possessing a persistent long-term effect, thus preventing the development of formidable complications and at the same time gently affecting its structural components.