For citation: Morozova S.V., Mityuk A.M. Physiological and clinical aspects of nasal breathing // RMJ. 2011. No. 23. S. 1405
The nose is the initial part of the respiratory system, it performs several functions that are most important for the human body: respiratory, protective, olfactory, warms and humidifies the incoming air.
The respiratory function of the nose is the transport of inhaled and exhaled air. The air flow passing through the nasal cavity experiences resistance from the intranasal structures. About 1 / 3⅓ of the total resistance falls on the movable part of the vestibule of the nose, 2/3 - on the area of the nasal valve - the narrowest part of the upper respiratory tract, located at the level of the anterior end of the inferior turbinate.
The resistance of the nose to the air flow is due to various factors. First of all, the degree of nasal resistance depends on the vessels of the inferior turbinates. With stagnation of blood in the cavernous venous plexuses, the shells swell, increase in size, which leads to a narrowing of the lumen of the nasal valve, sometimes to complete obstruction of the nasal cavity. Nasal resistance can be affected by various external influences and pathological processes in the nasal mucosa: inhalation of cold air, hyperventilation, allergies and inflammation, alcohol intake. In the supine position, resistance increases, and with atrophic processes in the nasal cavity, the use of vasoconstrictor drugs, physical activity, inhalation of oxygen, it decreases.
The air flow that passes through both halves of the nose is uneven. Usually in humans, there is a cyclical change in resistance to the air flow passing through the left and right halves of the nose, but the total resistance remains constant. The passage of air flow through the nasal cavity is regulated by the state of the cavernous venous tissue, which is located in the mucous membrane of the nasal cavity. With an increase in its size, a narrowing of the lumen of the nasal passages occurs, as a result of which the resistance to air flow increases. All this is called the nasal cycle.
Nasal cycle - cyclical changes in the degree of swelling of the nasal mucosa. The duration of the nasal cycle can be from 1 to 6 hours. The classical nasal cycle (described by R. Kaiser in 1895) consists of two phases: working (vasoconstriction) and rest (vasodilation), the change in the resistance of the air flow is strictly periodic. However, this is possible only if the nasal septum does not have pronounced deformation and is located in the midline. Otherwise, conditions arise that lead to a violation of cyclic changes in resistance, which can subsequently lead to the development of chronic rhinitis. Thus, the main physiological function of the nasal septum is to form the halves of the nasal cavity, that is, the paired organ.
Protective function. From the moment of birth, the nasal mucosa is constantly exposed to various factors, such as infectious agents, chemicals, temperature and physical factors of the air flow. Thanks to well-coordinated protective factors, the inhaled air is warmed, humidified, and also cleared of suspended particles, bacteria, viruses and fungal spores.
Mucociliary clearance (from the English clearance - cleansing) is the removal of rhinobronchial secretions, which is caused by the oscillatory movements of the cilia of the single-layer multilayer ciliated epithelium of the mucous membrane.
Mucociliary transport is one of the main mechanisms of the local defense system, which ensures the sanitation of the respiratory tract, the necessary potential of the barrier, immune and cleansing functions of the respiratory tract. Cleansing the respiratory tract from foreign particles, bacteria, chemicals occurs due to their settling on the mucous membranes and their subsequent excretion along with mucus.
The secret is a constantly updated filter. The upper layer of secretion is formed mainly due to mucins, 5-10% of it are neutral and acidic glycoproteins, which determine the viscosity of bronchial secretions (this depends mainly on intra- and intermolecular disulfide and hydrogen bonds, upon the destruction of which the viscosity decreases), 0.3 -0.5% - lipids (phospholipids from the alveoli and bronchioles).
Immunoglobulins (Ig) are secreted locally by plasma cells. IgA is functionally active in the proximal respiratory tract:
... inhibits the adhesion of a number of bacteria to the cells of the respiratory epithelium and prevents massive microbial colonization of mucous membranes, thereby reducing the risk of developing respiratory infections;
... actively participates in the regulation of the immune response;
... enhances phagocytosis;
... potentiates the antibacterial effects of lysozyme and lactoferrin;
... activates the complement system along an alternative path;
... inhibits NK-cell activity and antibody-dependent cellular cytotoxicity.
IgA has the ability to prevent viral replication. Its molecules can bind to tissue and foreign protein agents, removing them from the circulation and preventing the formation of autoantibodies.
Class G immunoglobulins are mainly involved in the antimicrobial protection of the distal parts of the bronchial tree. Their main biological and clinical significance is opsonization and interaction with components of the complement system. Opsonization accelerates microbial phagocytosis when IgG interacts with Fc receptors on the surface of neutrophils, monocytes, macrophages and natural killer cells.
The rhinobronchial secretion includes:
... lysozyme, which breaks down mucopolysaccharides and mucopeptides of the cell wall of many bacteria, acts as a mucolytic enzyme, which causes its bactericidal effect, and effectively resists fungal invasion;
... lactoferrin - a protein that binds iron ions, making it inaccessible for the metabolism of iron-dependent bacteria; thus, it acts bacteriostatically and protects tissues from the damaging effects of hydroxyl radicals;
... fibronectin, which prevents bacterial adhesion;
... interferons with antiviral activity.
The source of the formation of bronchial secretions is the bronchial glands, goblet cells, the epithelium of the terminal bronchioles and alveoli.
Rheological properties of rhinobronchial secretions. In accordance with the concept of two-layer secretion, mucus consists of an outer gel-like layer with a thickness of 2 μm (gel) and an underlying more liquid layer (sol) with a thickness of 2-4 μm. The coordinated beating of the cilia (16-17 times per second) promotes the advancement and removal of the secretion in the proximal direction.
The cilia have a very short period of relaxation, they transfer their kinetic energy to the outer gel-like layer. The daily volume of rhinobronchial secretion is on average 0.1-0.75 ml / kg of body weight. During normal activity of the mucociliary transport system, bacteria in the secret move at a speed of 10 cells of the bronchial mucosa in 1 s and during contact with the cell (up to 0.1 s) are unable to attach to the epithelium of the mucous membrane. The rate of mucociliary transport in a healthy person is approximately 4-20 mm per minute. For 24 hours, normally 10 to 100 ml of secretion is transported, which, getting into the pharynx, is swallowed or coughed up. Part of the bronchial secretion enters the bronchi from the alveoli. These are mainly the phospholipids of the surfactant formed in the terminal bronchioles and alveoli. Clinical manifestations of impaired mucociliary clearance in infections, allergies and other pathological conditions are cough, discharge of viscous mucous sputum, wheezing, bronchial obstruction, shortness of breath.
Olfactory function. The odoriferous substances that enter during inhalation irritate the endings of the olfactory nerve in the region of the olfactory gap. The interaction between odorant molecules and receptors located on the cilia of olfactory cells is possible only when combined with olfactory binding proteins located in the mucus of the nasal cavity. Olfactory neurons interact only with a specific set of odoriferous substances programmed for a given cell, that is, when molecules of an odorous substance penetrate into the olfactory region, a mosaic excitation of a group of neurons characteristic only of a specific odor occurs.
Violation of the sense of smell is possible in various diseases associated with both impaired delivery of odorants to the olfactory cells, and with the pathology of the sensitive endings and pathways of the olfactory analyzer. Hyposmia (decreased sense of smell) is a characteristic symptom of rhinitis and rhinosinusitis, which greatly reduces the quality of human life.
Warming and humidifying the air in the nasal cavity. When the flow of inhaled air passes through the nasal cavity, it is moistened and warmed almost to the temperature of the human body. This fact gives us the right to consider the nasal mucosa as a kind of physiological conditioner that prevents cold air from entering the lower respiratory tract, which is one of the main causes of acute colds. This ability for thermoregulation is due to the peculiarities of the blood supply to the mucous membrane of the nasal cavity: a peculiar structure of the vascular endothelium, arteriovenous anastomoses, choke veins, circulatory arteries. When environmental conditions change, there is a narrowing of the lumen of the nasal passages, a change in color, thickness of the mucous membrane, which is due to the speed and volume of blood flow.
In acute infectious or viral rhinitis, with inflammation of the nasal mucosa, all capillaries and precapillary sphincters relax, arteriovenous anastomoses open (vasodilation reaction), which ultimately leads to a maximum increase in the surface temperature of the mucous membrane.
The acceleration of blood flow is facilitated by an increase in pressure in the vessels of the microvasculature (small arteries, arterioles, capillaries, venules), which manifests itself in the form of local hyperemia. Allergic rhinitis and vasomotor rhinitis are characterized mainly by the presence of stagnation of venous blood in the cavernous vessels of the turbinates, which to a lesser extent causes an increase in temperature. With atrophic rhinitis, blood circulation in the mucous membrane is disturbed due to pathological changes in the walls of blood vessels of the type of obliterating endarteritis, which leads to a deterioration in blood supply, impaired microcirculation, and a decrease in mucosal temperature.
Humidification of the incoming air occurs throughout the respiratory tract up to the lobar bronchi, but nevertheless, the main department where humidity is regulated is the nasal cavity. The mucous membrane of the nose has a large reserve for air conditioning to the parameters required by the human body, even with a large amplitude of fluctuations in the level of humidity and ambient temperature. According to the results of calculations by N. Torelman (1960), carried out in normal room conditions, about 430 g of water vapor, mainly from the nasal cavity, is added to the inhaled air, 130 g of which condenses in the nose during exhalation. It follows from this that a person loses about 300 g of fluid per day due to evaporation from the upper respiratory tract. Thus, when the humidity of the inhaled air is maintained in the nasal cavity, optimal conditions are created for gas exchange in the lungs and the regulation of the water balance of the whole organism.
Physiological role
nasal breathing
When inhaling, the air flow passes through the nasal valve, while twisting into a spiral, then the turbulent vortex-like movement becomes laminar, and the air flow goes to the choanae along a curved line in the general nasal passage along the middle turbinate. At the same time, negative pressure is created in the upper respiratory tract with the help of the muscles of the chest, which leads to the release of part of the warmed humidified air from the paranasal sinuses and its attachment to the air flow going into the lungs. When you exhale through the choanae, air enters the nasal cavity and spreads to all nasal passages, but a significant part of the air flow in this case goes through the common nasal passage at the level of the inferior turbinate. Positive pressure is created in the nasal cavity, due to which part of the exhaled air is directed back to the paranasal sinuses. If breathing is carried out through the mouth, then the resistance to air flow is less, which leads to the disappearance of the difference between negative and positive pressure in the chest and abdominal cavities, which is necessary for the normal functioning of the cardiovascular system. When breathing through the mouth, ventilation of the lungs decreases by 25-30%, which significantly affects the saturation of blood with oxygen and carbon dioxide.
Violation of nasal breathing is one of the main components of various types of rhinitis. The modern etiopathogenetic classification of rhinitis was proposed by A.S. Lopatin (2010):
Rhinitis:
... Infectious:
... Spicy
... Viral
... Bacterial
... Traumatic
... Chronic
... Nonspecific
... Specific
... Allergic:
... Seasonal
... Year-round
... Intermittent
... Persistent
... Non-allergic rhinitis with eosinophilic symptoms (NARES):
... Vasomotor:
... Medication
... Hormone
... Rhinitis of pregnant women
... Rhinitis of puberty
... Food
... Cold
... Psychogenic
... Idiopathic
... Hypertrophic:
... Atrophic:
... Empty nose syndrome
... Ozena
... Diseases accompanied by symptoms of rhinitis (curvature of the nasal septum, polypous rhinosinusitis, cystic fibrosis, Kartagener's syndrome).
Acute infectious rhinitis is most often caused by viruses: adenovirus, influenza viruses, parainfluenza, respiratory syncytial virus, rhinovirus, picornavirus, reovirus. The main bacterial pathogens are Streptococcus pneumonae (pneumococcus), Streptococcus pyogenes and Haemophilus influenza. The spectrum of pathogens of chronic infectious rhinitis is much wider: Staphylococcus epidermidis, Staphylococcus aureus, Pseudomona ssp., Kleb-siella spp. and many others, including opportunistic bacteria. In people with immunodeficiency disorders (AIDS), rhinitis can be caused by fungi, bacterial-fungal associations, and opportunistic microorganisms.
The disease, which may be preceded by contact with a patient with ARVI and / or hypothermia, is characterized by an acute onset and simultaneously affecting both halves of the nose. The main symptoms: general disorder, difficulty in nasal breathing and discharge from the nasal cavity. These symptoms are expressed to varying degrees, depending on the stage of the disease. In the classical development of the disease, acute infectious rhinitis has three successive stages of the course, in each case expressed to a greater or lesser extent.
The first stage (reflex or prodromal) occurs shortly after hypothermia and lasts several hours. First, there is a spasm, and then a paralytic expansion of the vessels of the nasal cavity and turbinates. The patient has symptoms such as dryness in the nose and nasopharynx, difficulty in nasal breathing, tickling, scratching, burning, and sneezing. Along with this, general malaise, chills, heaviness and pain in the head appear. The body temperature rises quite often - up to 37 ° C or more. With anterior rhinoscopy, the nasal mucosa is hyperemic, dry.
The second stage (catarrhal or serous) lasts 2-3 days. It is characterized by the appearance of profuse serous discharge, nasal congestion, impaired sense of smell, sometimes lacrimation, congestion of the ears, and nasal voice. The mucous membrane of the nose is edematous, moist, hyperemic.
The third stage, which occurs on the 4-5th day from the onset of the disease, is characterized by the addition of bacterial inflammation. At the same time, the general condition of the patient improves, nasal breathing and sense of smell are gradually restored, but the discharge becomes mucopurulent and of a thicker consistency. With anterior rhinoscopy, the discharge is visualized in general, sometimes in the middle nasal passage and at the bottom of the nasal cavity.
The total duration of an acute rhinitis on average is about 8-12 days. The duration and severity of the disease is significantly influenced by the state of systemic and local immunity. The protracted nature of rhinitis (more than 3 weeks) is observed in weakened individuals who have chronic foci of infection in the upper respiratory tract, congenital and acquired anomalies of the nasal septum and turbinates.
Features of the course of rhinitis in children
In children, coryza is usually a symptom of an acute respiratory infection. The characteristic manifestations of the disease are difficulty in nasal breathing, dryness and burning of the mucous membrane, its edema, nasal congestion, profuse serous-mucous discharge.
Distinguish between acute rhinitis in older children and infants. Acute rhinitis is especially dangerous in newborns and infants. In the first months of life, due to the functional and morphological features of the central nervous system, adaptation to changes in the external environment in children is less perfect than in adults. In newborns, the ability to breathe through the mouth is reduced. In the first years of life, the nasal passages in children are narrow, and even a slight swelling of the mucous membrane can lead to obstruction of the nose, difficulty in nasal breathing.
Without nasal breathing, the child, after several sucking movements, stops sucking due to oxygen deficiency. The child becomes restless, his sleep is disturbed, body weight decreases, the temperature often rises, aerophagia develops. With a stuffy nose, the child breathes more easily with his mouth and with his head thrown back, in connection with which a false opisthotonus appears with tension in the fontanelles.
In childhood, inflammation in the nasal mucosa more often than in adults spreads to the nasopharynx (adenoiditis), the auditory tube (in children it is short and wide), the larynx, trachea, bronchi, and lungs.
In young children, rhinitis also has its own characteristics. General symptoms of intoxication prevail over local manifestations, which often worsens the general condition. Severe difficulty in nasal breathing complicates feeding. A child is not able to remove a large amount of discharge from the nasal cavity on his own. Rhinitis is often a factor in the development of inflammatory diseases of the lower respiratory tract.
Allergic rhinitis is a disease caused by allergens and characterized by IgE-dependent inflammation of the nasal mucosa. It is manifested by impaired nasal breathing, rhinorrhea, itching in the nose, sneezing, impaired sense of smell. According to the severity of symptoms and the degree of deterioration in the quality of life, mild, moderate and severe forms are distinguished. In mild form, sleep is normal; no disruption to daily activities.
Rhinitis in moderate or severe form can lead to sleep disturbance, daily activity, inability to fully carry out professional activities, study, exercise, rest; can manifest itself with excruciating symptoms.
Allergens, getting into the nasal cavity, partially settle on the ciliated epithelium and, entering into local contact, sensitize the body. When they re-enter the sensitized mucous membrane, an allergic IgE-dependent reaction is triggered. Allergic rhinitis is characterized by inflammatory infiltration of the nasal mucosa by various cells.
In patients with persistent allergic rhinitis, the degree of contact with allergens varies throughout the year, in some periods it is very low. But even in the absence of symptoms, these patients have minimal persistent inflammation in the nasal mucosa. The symptoms of persistent rhinitis are the result of an interaction between allergy triggers and an ongoing inflammatory response.
One of the main features of allergic rhinitis is nonspecific nasal hyperreactivity, which is characterized by an increased response to stimuli of a non-allergic nature that provoke sneezing, nasal congestion and / or rhinorrhea. It is caused by the following factors: destruction and increased permeability of the ciliated epithelium; increased release of mediators; an increase in the sensitivity of receptor, mediator and effector cells and an increase in the flow of afferent impulses in the central nervous system.
There is a direct link between allergic rhinitis and bronchial asthma. The main role in their pathogenesis is played by allergic inflammation of the mucous membrane of the nasal cavity and bronchi, formed by the same cells and mediators. A provocative bronchial test with a specific allergen in patients with allergic rhinitis leads to an asthmatic response involving inflammatory cells and pro-inflammatory mediators, and provocation of the nasal mucosa causes inflammation in the bronchi.
These facts substantiate the concept of “common airways”, which demonstrates a close relationship between allergic rhinitis and asthma. The inflammatory response can be sustained and enhanced by interrelated mechanisms, and patients with bronchial asthma and allergic rhinitis should receive combined treatment of the upper and lower respiratory tract.
The urgency of the problem of prevention and treatment of diseases of the nasal mucosa is due to the duration of their clinical course, as well as the complications they cause, which is often facilitated by the fact that most patients do not consult doctors in a timely manner or self-medicate. All this forces specialists to look for new therapeutic methods to eliminate the symptoms of rhinitis, control the course of the disease and prevent the occurrence of possible complications.
One of the common diseases that develop against the background of difficulty in nasal breathing is acute otitis media.
Acute otitis media is characterized by a pronounced staging of the course:
1. Acute eustachitis - dysfunction of the auditory tube, negative pressure in the tympanic cavity, noise in the ear, feeling of congestion, autophony, retraction of the tympanic membrane, shortening of the light cone.
2. Acute catarrhal inflammation, which is characterized by moderate pain in the ear and hearing loss, while the eardrum is hyperemic, thickened, identification marks are indistinct or absent.
3. Acute purulent inflammation, in which there is suppuration of serous exudate, in connection with which pain sensations increase sharply, symptoms of intoxication appear. Otoscopically: the tympanic membrane is sharply hyperemic, the identification marks are not visible, there is a bulging of the tympanic membrane of varying severity.
4. Postperforative stage, in which, due to the pressure of the purulent secretion and its proteolytic activity, a perforation is formed in the tympanic membrane, through which the pus is evacuated into the ear canal. The pain in the ear subsides, the general condition of the patient is gradually returning to normal. Otoscopically, the perforation of the tympanic membrane is determined, from which purulent discharge comes from.
5. Reparative stage - the inflammation in the middle ear stops, the perforation is closed with a scar.
The staging of acute otitis media suggests an individual approach to treatment at each of these stages. At the same time, it is very important to maintain the intact function of the auditory tube at all stages of acute otitis media. For this purpose, it is necessary to use nasal decongestants, topical glucocorticoids, blowing according to Politzer and catheterization of the auditory tube. Treatment of diseases leading to tubular dysfunction should be carried out: acute nasopharyngitis, sinusitis, acute rhinitis, adenoiditis.
Sinusitis is an inflammation of the paranasal sinuses. It is usually a complication of diseases such as acute rhinitis, scarlet fever, influenza, measles. Sinusitis can manifest itself in both acute and chronic forms. Variants of acute sinusitis - catarrhal and purulent, chronic - purulent, edematous-polyposis and mixed. Acute and chronic (during an exacerbation) sinusitis have a similar clinical picture: general malaise, fever, headache, nasal congestion (usually on one side) and abundant discharge from the nasal cavity. Therapy involves the use of both conservative and surgical methods. Conservative treatment includes the use of local antimicrobial agents, broad-spectrum antibiotics, mucoactive drugs. An important part of therapy is the use of nasal decongestants.
Adenoids - an increase in the pharyngeal tonsil due to hyperplasia of its tissue. Basically, adenoids affect children aged 3 to 10 years, with a complicated allergic history, problems of the immune status. Difficulty in nasal breathing, typical for adenoids, can lead to sleep disturbance, increased fatigue, lethargy, memory loss, academic performance (in schoolchildren), voice changes, nasal sounds, hearing impairment, persistent headaches, and the formation of an "adenoid" face. With first-degree adenoids and no complications, conservative treatment is used, including nasal decongestants; with a significant increase in adenoids or in the presence of complications, surgical treatment is effective.
Laryngitis is an inflammation of the mucous membrane of the larynx. There are two forms of laryngitis - acute and chronic. The reasons for the development of acute laryngitis are usually voice overstrain, hypothermia, acute infectious diseases. In acute laryngitis, the entire mucous membrane of the larynx or only some of its parts can become inflamed. In some cases, inflammation of the larynx can pass to the mucous surface of the trachea and lead to laryngotracheitis. Symptoms of acute laryngitis are perspiration, dry throat, pain when swallowing, cough, hoarseness, aphonia, headache. In some cases, laryngitis can lead to complications such as perichondritis of the laryngeal cartilage, sepsis and phlegmon of the neck. In the treatment of acute laryngitis, it is important to eliminate household and professional adverse factors.
Treatment of rhinitis depends on its form and severity of clinical manifestations and has the following goals:
... elimination of microbial pathogens;
... relief of the inflammatory process;
... restoration of nasal breathing, aeration of the paranasal sinuses, decrease in secretion;
... stimulation of reparative trophic processes in the mucous membrane;
... normalization of the functions of protective barriers: mucociliary transport and local immunity of the mucous membrane.
Various groups of drugs are used to treat rhinitis:
... nasal decongestants;
... antimicrobial;
... mucolytics, mucokinetics, mucoregulators;
... bacterial vaccines;
... means for carrying out irrigation therapy;
... astringents;
... medicines with complex action, combined and phytopreparations.
The possibility of clinical use of nasal decongestants deserves attention, since one of the main principles of rhinitis treatment is the restoration of nasal breathing. The mechanism of action of adrenergic agonists is to activate the α-adrenoreceptors of the vessels of the nasal mucosa and, as a consequence, to reduce the severity of its hyperemia and edema. The level of nasal secretion decreases, the drainage of the paranasal sinuses, nasal breathing, and aeration of the middle ear improve. The use of nasal decongestants helps to prevent complications - otitis media, eustachitis, sinusitis, and, which is also important, to improve the patient's well-being, normalize sleep and appetite, and restore working capacity.
The group of direct α-adrenergic agonists includes:
1) phenylaminoethanol derivatives: norepinephrine, adrenaline, phenylephrine;
2) imidazoline derivatives: naphazoline, xylometazoline, oxymetazoline, tetrizoline.
Means from the imidazoline group cause a rapid vasoconstrictor effect (reduction of swelling and hyperemia of the mucous membrane, relief of nasal breathing). But frequent and prolonged (more than five days) use of these adrenergic agonists can cause inadequate blood supply to the mucous membrane, up to the development of its atrophy in the future.
It should be borne in mind that the relative area of the nasal mucosa in children is much larger than in adults. Therefore, if an adult dose of a vasoconstrictor drug per 1 kg of body weight gets on the nasal mucosa of an infant, he will receive a dose 30 times higher than that of an adult. As a result of an overdose, there may be an increase in blood pressure, tremors, convulsions. Therefore, vasoconstrictor drugs in children, especially young children, should be used in minimal doses.
In addition, it should be remembered that the average therapeutic dose of some vasoconstrictor drugs (for example, naphthyzine) approaches its toxic dose, and therefore there is a high probability of overdose and systemic toxic effects from other organs with pronounced adrenergic innervation of blood vessels (brain, heart , digestive tract, etc.). When using drugs of the imidazoline group, the appearance of generalized systemic narrowing of blood vessels and disturbances in the blood supply to organs is possible, which will lead to a decrease in their nutrition.
In the case of use in children, the vasoconstrictor drug must meet certain requirements:
... have optimal characteristics and mechanism of action;
... do not cause morphological or functional damage to the mucous membrane, even with prolonged use;
... do not have systemic effects on the body;
... not to disrupt the motor activity of the ciliated apparatus of the epithelium, while the pH value of the drug itself should approach the physiological norm (7.0-7.3).
In recent years, with acute rhinitis in children, it is not recommended to use short-acting vasoconstrictor drugs: theofedrine, naphazoline and tetrizoline. This is due to the fact that after their use, the so-called recurrent edema of the nasal mucosa is observed. Preference is given to longer-acting vasoconstrictor drugs: oxymetazoline, xylometazoline, epinephrine, which makes it possible to reduce the frequency of administration.
A nasal decongestant widely used in both adult and pediatric practice is Vibrocil® - Vibrocil® (Novartis Consumer Health SA, Nyon, Switzerland). The drug contains two active ingredients - phenylephrine and dimethindeneamaleate. Phenylephrine has a vasoconstrictor effect on the venous network of the capillaries of the nasal mucosa.
Dimetindene maleate is an antihistamine component that reduces the manifestations of allergic and inflammatory reactions. The rationale for the creation of this drug was the following provisions. According to physiological data, all local vasoconstrictors have α-adrenergic activity, which causes narrowing of the blood vessels of the venous cavernous tissue of the mucous membrane (capacitive vessels), thus reducing tissue swelling and improving the conditions for air flow through the nasal cavity.
Studies of receptors have shown that resistant vessels that determine the blood flow of the nasal mucosa contain mainly α2-adrenergic receptors, while the capacitive vessels contain both α1- and α2-adrenergic receptors. Thus, both α1- and α2-adrenomimetics are able to influence the severity of vascular congestion. α2-adrenergic agonists, in addition, reduce the blood flow of the mucous membrane, cause ischemia and atrophy. The advantage of α1-selective adrenergic agonists is the ability to carry out a decongestant effect without affecting the function of the nasal mucosa.
Vibrocil® contains 250 μg of dimethindenamaleate, which blocks H1-histamine receptors, and 2.5 mg of phenylephrine, which selectively stimulates the α1-adrenergic receptors of the cavernous venous tissue of the nasal mucosa. At the same time, dimethindeneamaleate has an anti-allergic effect, and phenylephrine has a pronounced vasoconstrictor and anti-edema effect (quickly and permanently eliminates swelling of the nasal mucosa and its paranasal sinuses). The drug has no sedative effect.
The advantages of Vibrocil® are:
... combined anti-edema and hyposensitizing effect;
... absence of morphological and functional damage to the nasal mucosa (circulatory disorders, atrophy) even with prolonged use;
... lack of systemic effects in the form of generalized vasoconstriction and disorders of general blood circulation in young children;
... isotonicity. The pH value is comparable to that of the nasal mucosa, due to which rhythmic movements of the cilia of the ciliated epithelium are provided, mucociliary transport and the drainage function of the nasal cavity are preserved.
The drug is convenient for use in pediatric practice, since it is available in several dosage forms: in the form of a nasal spray, drops and gel. This allows it to be used more widely in children of different ages and to take into account the peculiarities of the clinical course of allergic rhinitis.
Nasal drops are instilled into each nostril 3-4 times / day. For children under the age of 1 year, a single dose - 1 drop; from 1 year to 6 years - 1-2 drops; over 6 years old and adults - 3-4 drops. Before using the drug, you should thoroughly clean the nasal cavity. Nasal drops are instilled with the head thrown back, and this position is maintained for several minutes. Infants are buried in the nose before feeding.
Nasal spray for children over the age of 6 and adults are prescribed 1-2 injections into each nostril 3-4 times / day. The spray should be held vertically, tip up. Keeping the head straight, insert the tip into the nostril, squeeze the nebulizer once with a short sharp movement and, removing the tip from the nose, unclench it. During the injection, it is recommended to inhale slightly through the nose.
Nasal gel for children over the age of 6 and adults is injected into each nostril (as deep as possible) 3-4 times / day. Its application just before bed ensures that there is no nasal congestion throughout the night.
Several schemes for the use of the drug have been proposed, which are actively used in clinical practice.
According to generalized data, the onset of the effect of Vibro-cy-la® in young children with manifestations of rhinitis occurred within 5-15 minutes. after using the drug, which was manifested by the absence of discharge from the nasal passages for 2-4 hours and a decrease in its amount in the next 2-3 hours on the first day from the start of treatment. On the following days, the discharge was absent for 4-5 hours. Complete disappearance of rhinitis symptoms - absence of serous-mucous discharge, disappearance of edema and hyperemia of the mucous membrane, restoration of airway patency - was noted in 17.3% of children on the third day, in 52.2 % - for the fourth, for 82.6% - for the fifth, for 95.6% - for the sixth and for 100% - for the seventh.
For acute rhinitis in newborns, Vibrocil® was prescribed 1 drop 2-3 times a day before feeding for 4 days. Then, during a 2-day break, the nasal mucosa was moistened with saline, followed by suction of the pathological contents. Then again Vibrocil® was prescribed for 4 days. After the first course in children, the amount of exudate in the nasal cavity, hyperemia and swelling of the mucous membrane decreased, the general condition improved, and the act of sucking milk was restored. After the second course, the symptoms of acute rhinitis completely regressed. No toxic or side effects were observed.
A wide range of dosage forms of Vibrocil® allows it to be used for various pathologies of the ENT organs, in the etiopathogenesis of which obstruction of nasal breathing plays a significant role. In addition, the advantage of this drug is the absence of a negative effect on the ciliated activity of the epithelium of the nasal mucosa. Vibrocil® can be recommended for use in the practice of medical and prophylactic institutions, including pediatric ones.
Literature
1. Berezhnoy VV, Unich NK, Yemets Ya. V. et al. The effectiveness of the use of Vibrocil in the treatment of acute rhinitis in young children // Sovrem. pediatrics. - 2003. - No. 1. - S. 49-52.
2. Zubkov M.N. Algorithm for the treatment of acute and chronic infections of the upper and lower respiratory tract // BC. - 2009. - T. 17. - No. 2.- S. 123-131.
3. Laiko A. A., Bredun O. Yu. - 2005 .-- S. 121-122.
4. Lopatin A.S. Rhinitis. - M .: Litterra, 2010 .-- S. 122, 126-127.
5. Acute respiratory diseases in children: treatment and prevention. Scientific and practical program of the Union of Pediatricians of Russia. - M .: International Fund for Maternal and Child Health, 2002. - 69 p.
6. Palchun V.T., Magomedov M.M., Luchikhin L.A. Otorhinolaryngology. - M .: Medicine, 2007 .-- S. 114-117.
7. Piskunov G.Z., Piskunov S.Z. Clinical rhinology. / A guide for doctors. 2nd ed. - M .: Medical Information Agency, 2006 .-- S. 183, 190, 202-205.
8. Ryazantsev S.V., Kocherovets V.I. Etiopathogenetic therapy of diseases of the upper respiratory tract and ear. Guidelines. - SPb., 2008 .-- 120 p.
9. Tatochenko VK Treatment tactics for acute diseases of the nasopharynx. // RMJ. - 1999. - No. 7 (11). - S. 520-522.
10. Turovsky A.B., Miroshnichenko N.A., Kudryavtseva Yu.S. Allergic rhinitis. Diagnostics and treatment. // RMJ. - 2011. - T. 19. - No. 6. - P. 409.
11. Turovsky A.B., Tsarapkin G.Yu., Zavgorodniy A.E. Antibiotics Socially significant diseases. - 2007. - T. 15. - No. 22 - P. 1676.
12. Unich NK, Koroleva VA, Loboda RN and others. The use of Vibrocil in the treatment of acute rhinitis in young children // Sovrem. pediatrics. - 2003. - No. 1. - S. 49-52.
13. Bucaretchi F., Dragosavac S., Vieira R. J. Acute exposure to imidazoline derivatives in children. // J. Pediatr. r. (Rio J). 2003. - Nov-Dec. - No. 79 (6). - P. 519-524.
14. Claudet I., Fries F. Danger of nasal vasoconstrictor in infants. Aproposof a case. // Arch. Pediatr. - 1997. - Jun. - No. 4 (6). - P. 538-541.
15. Mahieu L. M., Rooman R. P. Goossens E. Imidazoline intoxication in children. // Eur. J. Pediatr. - 1993. - Nov. - No. 152 (11). - P. 944-946.
16. Hochban W., Althoff H., Ziegler A. Nasal decongestion with imidazoline derivatives: acoustic rhinomanometry measurements. // Eur. Journal of clinical pharmacology. 1999. No. 55.
Everyone knows how important breathing is for maintaining the vital functions of the body. But few people think about how even a slight violation of normal nasal breathing can affect the state of various systems of human organs.
Various anomalies of the upper respiratory tract, not detected in a timely manner and not cured diseases (adenoids, sinusitis, rhinitis, curvature of the nasal septum, etc.), as well as a number of other reasons can lead to the development of difficult to eliminate or generally irreparable pathological changes in the nasal mucosa, to disruption of normal nasal breathing, which further contributes to the occurrence of diseases of various body systems.
Due to difficulty in nasal breathing, there is a "transition" to breathing through the mouth. Such people usually sleep with their mouths open, their sleep is restless, intermittent and often accompanied by snoring. No matter how long they sleep, patients with impaired nasal breathing constantly complain that they do not get enough sleep, so they usually look lethargic and apathetic. For this reason, schoolchildren, students, for this reason, there is often a decrease in academic performance, a weakening of memory and attention occurs, in adults, a decrease in working capacity is noted, they become irritable.
In the nose, the inhaled air is purified, moistened, and warmed. When breathing through the mouth, untreated (this is in our ecological situation !!!), dry and cold air enters the lungs, which inevitably entails diseases of the lungs and bronchi.
Frequent in such patients and complaints of headache, as a result of the obstructed outflow of blood and lymph from the brain, this condition is explained by congestion in the nasal cavity.
The most dangerous thing is “wrong breathing” for a growing organism. Constant breathing through the mouth leads to deformation of the facial skeleton. These children often have a malocclusion. As a result of prolonged difficulty in nasal breathing, the chest is deformed. Lung ventilation is impaired, blood oxygen saturation decreases, the number of red blood cells and hemoglobin content decreases.
When breathing through the mouth, there is less resistance to air flow, as a result of which the development of positive and negative pressure in the chest cavity is suppressed, which is necessary for the normal functioning of the heart.
Thus, a violation of nasal breathing is reflected not only directly on the respiratory organs, but can also lead to significant pathological changes throughout the body. When a person switches to breathing through the mouth, the entire mechanism of functioning of various organs and systems is disrupted. Respiratory rhythm, blood outflow and brain nutrition are disturbed, and as a result - memory impairment, mental abilities, impaired blood composition, functions of the cardiovascular system ...
When breathing through the nose, the air stream makes a peculiar path. The main mass of air is directed upward in an arc-like manner, from there it descends downward and posteriorly, to the choans. When exhaling, the air rushes in the opposite direction along the same path, entering the olfactory region somewhat. This path of passage of the air stream is confirmed by a number of experiments. So, Paulsen (Paulsen) passed through the nose of a vapor of osmic acid. The location of the browning of the mucous membrane served as an indicator of the path of passage of air saturated with these vapors. In Kayser's experiments, the air passage was marked by deposited magnesia dust. Franke, in experiments on cadavers, replaced the nasal septum with a glass plate and let tobacco smoke pass through one half of the nose. Observing the movement of smoke through a glass partition, the author judged the path of its passage. All these experiments have fully confirmed the path indicated above, which is made by the air inhaled through the nose.
Nasal breathing is a normal physiological act, and its violation causes various pathological conditions of the whole organism. Gas exchange in the lungs decreases, as a result of which the alkaline reserve of blood decreases. In particular, oxygen exchange is disturbed, as a result of which the amount of hemoglobin and red blood cells decreases. There is a weakening of lung ventilation, hypoxemia and hypercapnia (Saufer - Saufer, Rugoni - Rugoni, ME Gindes, EN Pavlovsky, II Shcherbatov).
Turning off and obstructing nasal breathing affects the work of the heart and blood pressure. There comes a weakness of cardiac activity, the rate of circulation of blood in the lungs decreases, pathomorphological changes occur in the nerve nodes and in the muscle of the heart, blood pressure rises (MF Tsytovich, EN Pavlovsky, ND Korolev, BN Lukov, A.G. Bondarenko and V.V. Gromov).
Switching off nasal breathing is accompanied by a decrease in lymphatic movement, changes in intraocular, intracranial and spinal pressure (V. A. Aleksandrovskaya, M. V. Kochurova and A. V. Savelyev, V. K. Trutnev and V. V. Gromov, L. E. Komendantov) , weakening of ventilation of the paranasal sinuses and middle ear cavities (M.F.Tsytovich), impaired absorption of the nasal mucosa (V.K.Trutnev and V.V. Gromov, O. V. Urbakh, A. A. Arutyunov), motor and secretory function of the gastrointestinal tract and liver function (A. G. Bondarenko, V. V. Gromov, I. D. Khristoforov, P. E. Ermolaev, E. N. Pavlovsky).
When nasal breathing is turned off, the morphological composition of the blood and its physicochemical properties change. The number of erythrocytes decreases, the hemoglobin content decreases and the number of leukocytes increases (N.V. Belogolovov, V.G. Ermolaev, A.G. Likhachev), the erythrocyte sedimentation reaction accelerates (I.D. Khristoforov and V.V. Gromov), an increase in blood sugar (R.I.Moshin), a decrease in the level of lactic acid in the blood (M.Ya. Shapiro), an increase in the amount of calcium (D.N. Semenov), the residual nitrogen of the blood rises (N.A. Bobrovsky).
The variety of changes in many functions can be explained by the influence of switching off nasal breathing on the function of the central nervous system. This assumption is confirmed by the research data of many authors. When nasal breathing is turned off, an increase in intracranial pressure occurs (A. Ya. Shapiro, N.D. Khodyakov), a disorder of cerebral circulation and movement of cerebral fluid, hyaline degeneration of the inner and middle membranes of cerebral vessels (S.F. Gamayunov), difficulty in the outflow of cerebrospinal fluid from the cranial cavity. All these disorders of blood and lymph circulation in the brain, apparently, lead to a violation of higher nervous activity, which results in a disorder of the body's vital functions. This opinion is supported by the studies of E.S. Viktorova, who, by the method of conditioned reflexes, proved that switching off nasal breathing leads to a sharp suppression of the cerebral cortex. VA Bukov believes that in violation of nasal breathing, the disorder of the body as a whole is due to the shutdown of afferent impulses coming from the receptor fields of the nasal mucosa.
The upper respiratory tract plays a more important role in the vital activity of the organism than it was previously thought.
This part of the respiratory system is important for warming, humidifying and purifying the inhaled air, for speech function, but its significance is not limited to this. The upper respiratory tract has very sensitive receptor zones, the excitation of which reflexively affects various physiological systems. Conversely, the mucous membrane of the nose (and larynx) easily reacts to reflex influences. For example, when the legs are cooled, a vasomotor reaction of the nasal mucosa occurs.
Nasal breathing is of great importance for the proper development of the body and the normal functioning of respiration, blood circulation, lymph circulation, nervous system, etc. It has long been noticed that when the mucous membrane of the nose and accessory cavities are disturbed, the functions of other organs are disturbed. It is known that there is a connection between their condition with the development of bronchial asthma, with visual impairments, with ear diseases, impaired gastric secretion, abnormalities in sexual function, with the development of cardiac neuroses, even with attacks of angina pectoris. It is known that with disturbances in the nasal passages and in the accessory cavities, higher nervous activity suffers. Each of us noticed that a "simple" runny nose reduces mental performance, causes easy fatigue, headache.
When a child's nasal breathing is turned off due to the growth of adenoids and he breathes through his mouth, the appearance changes so characteristic that he received the name "adenoid mask".
It is important that this slows down mental development: absent-mindedness arises, memory and hearing are weakened. Headaches, dizziness, bedwetting and other disorders of nervous function appear.
So, long-term difficulty and even more, the shutdown of nasal breathing leads to a weakening of the most important functions - respiratory, blood circulation, lymph circulation, liver, kidneys, endocrine system, nervous activity .
In the experiment, these observations were confirmed and to some extent explained.
When the oral type of respiration was artificially induced in animals, a significant weakening of the circulation of tissue fluid was observed. Stagnation developed in the vascular system of the eye. The blood and lymph circulation of the head was impaired, and the intracranial pressure increased.
It turns out that at nasal breathing synchronously with respiratory movements, the pressure in the vessels of the brain fluctuates... Apparently, this is essential for blood flow in the brain. Breathing through the mouth becomes more beneficial only when the breathing tension is very high during a heavy load. Narrow nasal passages create significant resistance to air flow, which is not felt during moderate operation. Maximum pulmonary ventilation with oral breathing reaches 228 l / min, with nasal breathing - only 85 l / min. During normal nasal breathing, the receptors of the nasal mucosa (the end of the trigeminal and olfactory nerves) and the larynx (the superior and inferior laryngeal nerves) are rhythmically irritated by changes in pressure, temperature, humidity, carbon dioxide and other substances contained in it. The excitation of these receptors greatly affects the respiratory center. It can even suppress the Hering-Breuer reflex (inspiratory-inhibitory, or hyper-airy reflex). The essence of this reflex is that it is triggered by a significant volume of inhaled air. The resulting increase in lung volume increases impulses from stretch receptors in the airways, and leads to cessation of inspiration. It is believed that the Hering-Breuer reflex develops with a tidal volume exceeding 1.5-2.0 liters.
With the complete exclusion of the upper tract from breathing and with artificial ventilation of the lungs, a complete picture of asphyxiation of the animal (asphyxia) may occur.
Excessive irritation of the receptors of the upper respiratory tract with an emulsion of turpentine, alcohol causes the rapid death of animals with phenomena that resemble traumatic shock. Inhalation of high concentrations of ammonia, irritating CWA, can also cause instant death from reflex spasm of the glottis and inhibition of the respiratory center.
Inflammation of the mucous membrane of the upper respiratory tract significantly increases the excitability of the receptors. A prolonged increase in the flow of impulses into the respiratory center in this case causes parabiotic inhibition and respiratory arrest. It has been noticed that with inflammation of the upper respiratory tract in athletes (even if it does not mechanically interfere with breathing), their athletic performance decreases. A burn of the upper respiratory tract with general burns always greatly worsens the prognosis. So, the state of the upper part of the respiratory system, both under normal and pathological conditions, is important for the vital activity of the body, although breathing is possible without their participation.
Empirically, for a long time, for a therapeutic purpose, effects on the body through the upper respiratory tract have been used:
ü used the inhalation of pleasant odors (pressure decreases and pulse decreases);
ü weak ionogalvanization of the nasal mucosa was used in the treatment of hypertension, peptic ulcer, bronchial asthma;
ü irritation of the receptors of the nasal passages by inhalation of ammonia, "smelling salt" to excite the cerebral cortex in case of fainting;
ü prolonged breathing of cool and cold air is used to treat various diseases (in particular, pneumonia in children). This is especially important with prolonged bed rest (for example, in patients with tuberculosis).
How we breathe - fast or slow, shallow or deep, chest or belly - affects our mood, stress levels, blood pressure, immune function, and many other processes in the body.
Most people have no control over their breathing. It should be noted that the higher the respiratory rate, the greater the likelihood of serious health problems.
So how do you breathe properly and with health benefits?
The first and most important rule of healthy breathing is to always breathe through your nose, even during exercise.
Breathing through the nose is most correct and optimal, while breathing through the mouth reduces tissue oxygenation, increases heart rate and blood pressure, and has many other adverse health effects.
The benefits of nasal breathing are obvious.
First, nasal breathing helps fight infections. Our nose is the only organ that can properly “prepare” the air we breathe. The air passing through the nasal passages is heated, humidified, conditioned and mixed with nitric oxide, which has two important functions: it kills pathogens and acts as a vasodilator in the respiratory tract, arteries and capillaries.
When breathing through the mouth, there are no barriers that prevent the entry of pathogenic microbes into the body.
Secondly, nasal breathing provides better blood flow and lung volume. Vasodilation by nitric oxide increases the surface area of the alveoli, so that oxygen in the lungs is absorbed more efficiently.
Nasal breathing (as opposed to breathing through the mouth) improves blood circulation, increases blood oxygen and carbon dioxide levels, slows down breathing rate and increases total lung volume.
Constant breathing through the mouth causes the airways to narrow.
When breathing through the mouth, the lungs are overstimulated with oxygen, but since the air supplied in this way is not humidified and the vessels are not sufficiently dilated, the actual absorption of oxygen through the alveoli is much lower than with nasal breathing.
Third, nasal breathing is involved in the body's thermoregulation, helping to maintain body temperature.
Fourthly, breathing through the nose improves brain activity and the functioning of all organs and systems of the body.
The hypothalamus is a small area in the diencephalon that includes a large number of groups of cells (nuclei) that regulate the neuroendocrine activity of the brain and homeostasis of the body. The hypothalamus is responsible for many functions in our body, especially those that we consider automatic: heartbeat, blood pressure, thirst, appetite, sleep and wake cycles. It is also responsible for the production of chemicals that affect memory and emotions.
Nasal breathing, as part of the respiratory process in the body, is also controlled by the hypothalamus. With an increase in the air flow through the right nostril, an increase in the activity of the left hemisphere of the brain, which is responsible for logic and analysis, is observed, and with an increase in the air flow through the left nostril, an increase in the activity of the right hemisphere of the brain, which is responsible for the processing of non-verbal information and spatial orientation, is observed.
When we breathe through the mouth, we deny optimal oxygenation to our heart, brain and all other organs, as a result of which arrhythmias and other heart diseases can develop.
Fifth, nasal breathing helps with high physical exertion, including during exercise.
In the lungs, oxygen is extracted from the incoming air primarily during exhalation. When we breathe out through the nose, resistance is created in the airway, which slows down the speed of the exhaled air, while at the same time the absorption of oxygen by the lungs increases. Carbon dioxide is not just a waste product of our body, it plays a large biological role, one of which is to help in the utilization of oxygen.
When the level of carbon dioxide in our body is too low, the acid-base balance is disturbed, the pH of the blood changes, which leads to a deterioration in the ability of hemoglobin to release oxygen to our cells (the Verigo-Bohr effect). The Verigo-Bohr effect was discovered independently by the Russian physiologist B.F. Verigo in 1892 and the Danish physiologist K. Bohr in 1904, and it depends on the degree of dissociation oxyhemoglobin on the value partial pressure carbon dioxide in the alveolar air and blood. With a decrease in the partial pressure of carbon dioxide in the blood, the affinity of oxygen for hemoglobin increases, which prevents the transfer of oxygen from the capillaries to the tissues.
Nasal breathing creates about 50% more resistance to airflow in healthy people than breathing through the mouth, and helps to slow down the respiratory cycle, reduce the number of respiratory movements, which leads to an increase in oxygen uptake by 10-20%.
Thus, if we want to improve our physical performance, we should breathe through our nose during physical activity. The intensity of sports activities must be adjusted according to breathing. If you feel that you are not breathing through your nose, you need to slow down the pace of your workout. This is a temporary phenomenon, after a fairly quick period of time, the body will begin to adapt to the increased level of carbon dioxide.
Sixth, nasal breathing has a therapeutic effect. Proper nasal breathing can lower blood pressure and reduce stress levels.
Breathing through the mouth can lead to malocclusion, changes in the anatomy of the face in children, and impairs the quality of sleep, as a result of which we look and feel tired. Also, breathing through the mouth accelerates the loss of water, which can lead to dehydration.
Mouth breathing skips many important steps in this physiological process, which can lead to health problems such as snoring and sleep apnea. Breathing through the mouth promotes hyperventilation, which actually decreases tissue oxygenation. Mouth breathing also results in lower levels of carbon dioxide in the body and a decrease in the lungs' ability to filter out toxic pollutants from the air.
Mouth breathing can be used in an emergency. During hypoxia, our body reflexively reacts to a lack of oxygen, starting to yawn, thus trying to increase the amount of air supplied.
Next time, we'll look at a few controlled breathing techniques that can help you improve your health.
Breathe correctly and be healthy!
Sources: http://www.whogis.com/ru/
Loading ...