Pediatric bronchitis refers to inflammation of the bronchi, and the most common and serious form of pediatric bronchitis is pediatric capillary bronchitis, which occurs in winter and can cause localized epidemics. Pediatric capillary bronchitis occurs mainly in the tiny bronchi of the lungs, or capillary bronchi, hence the name “capillary bronchitis”, and is usually a complication of viral infections such as the common cold, influenza, or bacterial infections.
The pathogen of capillary bronchitis is mainly respiratory syncytial virus, which can account for 80% or more; others are adenovirus, parainfluenza virus, rhinovirus, and influenza virus in that order; a few cases can be caused by Mycoplasma pneumoniae; after infection with the virus, the tiny capillary bronchi become congested, edematous, and have increased mucus secretion, plus necrotic mucosal epithelial cells shed and block the lumen, leading to significant emphysema and atelectasis. The inflammation often involves the alveoli, alveolar wall and interstitial lung, so it can be considered a specific type of pneumonia.
Capillary bronchitis, unlike general bronchitis or bronchiectasis, has clinical symptoms like pneumonia but with wheezing as the main cause. This disease occurs mostly in children under 2.5 years of age, 80% within 1 year of age, and mostly in children under 6 months of age.
Clinical manifestations
Typical capillary bronchitis often occurs after 2 to 3 days of upper respiratory tract infection, with a persistent dry cough and fever, with a moderate to low fever, characterized by episodes of wheezing, which is more severe 2 to 3 days after the onset of wheezing, with significantly faster breathing during the onset of wheezing, up to 60 to 80 times per minute or more, accompanied by prolonged expiration and expiratory wheezing; children with severe disease clearly show nasal stirring and In severe cases, the child clearly shows nasal stirring and “three concave signs” (i.e., supraclavicular fossa, suprasternal fossa and epigastric depression during inspiration), pale face, blue around the mouth, or cyanosis, and the child is often irritable and moaning; in more severe cases, the child may be combined with heart failure or respiratory failure, and most cases can be relieved after treatment, and death rarely occurs.
Treatment
Children should be sent to the hospital promptly after the onset of the disease. Since capillary bronchitis is mostly caused by viral infections, the early onset of the disease generally does not require antibiotic treatment. The treatment is mainly symptomatic and can be summarized as “sedation and cough suppression”, in addition, good care is also important, especially pay attention not to disturb the child, make it rest quietly, maintain a certain humidity in the room, replenish enough low water, serious children can be combined with nebulized inhalation, and In severe cases, nebulizer inhalation and sputum aspiration can be used to keep the respiratory tract open, and traditional Chinese medicine can also be used.
Symptoms and signs
1. It is most common in children under 1 year old, especially in infants under 6 months old.
2. The disease can develop throughout the year, but it is more common in winter and spring.
3. The onset of the disease is rapid, with pre-cold symptoms such as coughing and sneezing, and the cough worsens after 1 to 2 days, with episodes of dyspnea, wheezing, pallor, cyanosis of the lips and trismus. In severe cases, the symptoms may be accompanied by congestive heart failure, respiratory failure, hypoxic encephalopathy, and water and electrolyte disturbances. The general temperature does not exceed 38.5℃, and the duration of the disease is 1 to 2 weeks.
4. Blood leukocytes are mostly normal or mildly increased. Blood gas analysis shows hypoxemia and decreased or increased partial pressure of arterial blood carbon dioxide. Chest x-ray shows thickened lung texture, increased translucency of both lungs or small shadows and pulmonary atelectasis. A rapid diagnosis of respiratory secretion virus can be done if available to clarify the virus type.
Clinical features
The onset of pediatric capillary bronchitis can be acute or slow. Most of them have symptoms of upper respiratory tract infection first, or they may suddenly develop a frequent and deep dry cough, followed by a gradual bronchial secretion. Infants and young children do not produce sputum, and most swallow it through the pharynx. The symptoms are not obvious in mild cases, but in severe cases, the fever is 38-39℃, occasionally up to 40℃, and it will recede in 2 to 3 days. Fatigue, sleep and appetite, and even vomiting, diarrhea, abdominal pain and other gastrointestinal symptoms occur. Older children again complain of headache and chest pain. The cough usually lasts for 7 to 10 days and sometimes lasts for 2 to 3 weeks, or recurs. Without proper treatment, pneumonia may develop. Leukocytes are normal or slightly low, and those with elevated levels may have secondary bacterial infections. Complications are rare in able-bodied children, but in malnourished, immunocompromised, congenital respiratory malformations, chronic nasopharyngitis, rickets, etc., children are not only prone to bronchitis, but also to pneumonia, otitis media, laryngitis, and paranasal sinusitis.
Home care
Bronchitis is a common respiratory disease in children and has a high prevalence, occurring throughout the year, with a peak in the winter and spring. When bronchiolitis occurs, children often have varying degrees of fever, cough, loss of appetite or vomiting, diarrhea, etc. Younger children may also have capillary bronchitis manifestations such as wheezing and wheezing. Although a small number of children may develop bronchopneumonia, most of them have a mild condition and are treated with medication and care at home.
1. Keeping warm
Temperature changes, especially cold stimulation can reduce the local resistance of the bronchial mucosa and aggravate bronchitis, therefore, parents should increase or decrease clothing for the child in time with the temperature changes, especially when sleeping to cover the child well, so that the body temperature is kept above 36.5 ℃.
2. Feed more water
In the case of pediatric bronchitis, there are varying degrees of fever and water evaporation, so attention should be given to feeding the child more water. You can use sugar water or sugar saline supplement, also can use rice soup, egg soup supplement. The diet is mainly semi-liquid to increase body water and meet the needs of the body.
3, adequate nutrition
When children suffer from bronchitis, the nutrient consumption is large, coupled with fever and bacterial toxins affect the gastrointestinal function, poor digestion and absorption, so the lack of nutrients in the child’s body is not negligible. In this regard, parents should take a small number of meals for the child, give light, nutritious, balanced and easy to digest and absorb semi-liquid or liquid diet, such as thin rice, boiled noodles, egg custard, fresh vegetables, fruit juice, etc.
4.Turn and pat the back
When a child coughs and coughs up sputum, it indicates an increase in bronchial secretions. To promote the smooth discharge of secretions, nebulized inhalers can be used to help expectoration, 2-3 times a day for 5-20 minutes each time. In the case of infants, in addition to patting the back, the child should be helped to turn over once every 1-2 hours to keep the child in a semi-recumbent position, which is favorable to the discharge of sputum.
5.Anti-fever
If the body temperature is below 38.5℃, there is no need to give antipyretic drugs, but mainly to treat the cause of the problem. If the body temperature is high, older children can be given physical cooling, that is, wet compresses with cold towels on the head or bath with warm water, but young children should not use this method, if necessary, the application of drugs to lower the temperature.
6, maintain a good family environment
The room where the child lives should be warm, well ventilated and lighted, and the air should have a certain humidity to prevent excessive dryness. If there are smokers in the home, it is best to quit smoking or go outside to prevent the adverse effects of smoke on the child.
Clinical diagnosis
I. Clinical manifestations
1. Initially, there is fever, chills, headache, dry throat, etc.
2. The main symptoms are coughing and coughing up sputum.
Main types
1.The initial stage of acute bronchitis is dry cough with gradually increasing sputum volume, which gradually becomes mucopurulent sputum.
2.Chronic bronchitis is mainly a persistent cough, which does not heal for many months and is aggravated in the morning and evening, especially at night. The amount of sputum is more or less, and the coughing out is fast. The symptoms are lighter in the summer and prone to acute attacks in the winter, making the condition worse. Recurrent attacks are associated with a thin body. It can be complicated by pulmonary atelectasis, emphysema and bronchiectasis.
Physical and chemical tests
1. Early respiratory sounds may be coarse, and vesicular sounds may be heard bilaterally.
2.X-ray examination: acute cases may have no special findings. Chronic cases may have corresponding chronic inflammatory changes.
Differential diagnosis
1.In milder cases, it must be differentiated from upper respiratory tract infection.
2, bronchial foreign body: when there is a respiratory obstruction with infection, its respiratory symptoms are similar to acute bronchitis, attention should be paid to ask whether there is a history of respiratory foreign body inhalation, after treatment, the efficacy is not good, prolonged, recurrent episodes. Chest X-ray examination shows obstruction such as pulmonary atelectasis and emphysema.
3, pulmonary hilar bronchial lymph node tuberculosis: according to the history of tuberculosis contact, tuberculin test and chest X-ray examination.
4, capillary bronchitis: mostly seen in infants under 6 months of age, with obvious acute episodes of wheezing and dyspnea. The body temperature is not high, and the pulmonary rales are not obvious during wheezing episodes, and fine wet rales can be heard after remission
5. Bronchopneumonia: When the symptoms of acute bronchitis are severe, it should be differentiated from bronchopneumonia.
Treatment
I. Control of infection
Acute bronchitis such as bacterial infection, the following antibacterial drugs can be used: cotrimoxazole 0.05/kg/day in two oral doses, penicillin 30-50,000 U/mg/day in two intramuscular injections, methicillin, erythromycin 30-50 mg/kg/day in 3-4 oral doses. If there is no clear bacterial infection or mixed infection, use or add virazole 10-15 mg/kg/day in 2 times intramuscular injection, or 5 mg/kg/day in 2 times for nebulized inhalation, or try a-interferon 200,000 U/day intramuscular injection.
Second, symptomatic treatment
1, cough expectorant: If the sputum is sticky and not easy to suck out, use nebulized inhalation and choose 10% ammonium chloride combination, must be cough flat, pediatric strong phlegm Ling (2-4 years old 1-2 tablets, 5-8 years old 2-3 tablets). Frequent dry cough affects sleep and rest, a small amount of cough suppressant can be taken, such as compound forcodine syrup, 2-3 times a day, attention should be paid to avoid overdose and too long, affecting the physiological vitality of cilia, so that secretions are not easily discharged.
2, antispasmodic and asthma should be preferred to nebulized inhalation treatment, can be combined with inhalation budesonide nebulized solution 2ml, isopentopine bromide solution 1ml, salbutamol solution 0.5ml, saline 1ml together with nebulized inhalation 5-7 days. If the effect is not good, aminophylline can be given: 2-4 mg/kg/time 3-4 times/day orally. Salbutamol: 1-2 mg/day in 3-4 oral doses or 0.1 mg/kg/time under 6 years old. If wheezing is serious, add prednisone 1 mg/kg/day in 3 oral doses for 4-7 days.
C. Chinese medicine treatment
1.Cough and wheezing: In the remission period, you can use some cough and wheezing Chinese medicine preparations, which can also reduce the symptoms to a certain extent.
2, external paste medicine: many infants and children after the disease, long-term medication can bring some drugs toxic pay effect, the safety and convenience of external paste Chinese medicine is also not a good way. At present, the more used are the expectorant, pulling phlegm of the Bacchus agaricus Yi Qi paste and winter with the Sanjiu paste.
Four, massage treatment
Through Chinese medicine massage techniques, massage and massage of acupuncture points for children with bronchitis symptoms to unblock the breath to achieve therapeutic effects. At present, some of the well-known pediatric massage clinics are Shanghai Kang Yao Pediatric Tuina, Qingdao Pediatric Tuina, and Beijing Yuming Pediatric Tuina.
Method of medication
Children suffering from bronchitis should pay attention to rest, keep the air in the bedroom circulating, and maintain the appropriate temperature and humidity. Give easily digestible food and drink plenty of boiled water. Provide vitamin B complex and vitamin C, 1 tablet each time, 3 times a day. For children with chronic and multiple attacks, provide vitamin AD, 1 tablet each time, 2-3 times a day. For young and weak children, oral sulfonamides or penicillins can be given for mild cases, and certain phlegm-suppressing drugs can be used for synergistic treatment. Sulfonamides can be used with cotrimoxazole, 20 mg per kg of body weight per day, divided into two oral doses. Due to the slow excretion of sulfonamides, it is easy to cause crystalline precipitation in the kidneys, so it is necessary to supply sufficient water during the medication to facilitate excretion. Some children are allergic to sulfonamides. After the use of rash, exfoliative dermatitis, etc., if encountered with a history of allergies can not be used. Amoxicillin can be used for penicillins, 40-80 mg per kg of body weight per day, taken orally in 3-4 doses after meals. Oral penicillin drugs should also pay attention to the history of penicillin allergy, and should be used with caution in children with penicillin allergy, and should even be prohibited in children with atopic constitution, as well as those who are prone to allergic reaction. Such children can switch to the cephalosporin drug cefradine, 25-50 mg per kg of body weight per day, divided into 3-4 doses. The phlegm-suppressing drugs can be used as phlegm-suppressing tablets, 1/2 a l tablet each time, 3 times a day.
For allergic coughs caused by various reasons, elevated eosinophil counts can be found by blood tests, and such coughs often have a long duration, so the anti-allergy drug loratadine can be added for oral administration. Children with recurrent bronchitis should be allowed to actively participate in physical exercise to improve their physical fitness, pay attention to changes in the cold and warm climate, and avoid wearing too much or too little clothing. If bronchitis does not heal repeatedly, you should go to the hospital to check carefully for bronchial congenital malformations, bronchial dilatation, hypoproteinemia, tuberculosis and chronic sinusitis, tonsillitis and other diseases.
Preventive care
First of all, pay attention to children’s hot and cold, don’t dress too hot, and let him have proper cold-tolerance exercise. When the temperature is high, don’t just think about the child being cold, but more importantly, always be careful not to let the child get hot, so that he or she doesn’t sweat and get cold more easily. If your child has a cold, give him/her some medicine as early as possible so as not to delay the illness.
Complications
1, bronchopneumonia: children can develop high fever, hypoxia, respiratory distress, acute respiratory failure, and even complications such as pulmonary atelectasis, emphysema, pus, pneumothorax, lung abscess, pericarditis, sepsis, etc., which can be life-threatening.
2, bronchial dilatation: When pediatric bronchitis is not treated properly, it can turn into chronic bronchial purulent inflammation, which destroys the bronchial wall so that the bronchial wall is deformed and dilated, and the wall tissue is destroyed, causing the bronchial tubes to lose their original natural defensive capabilities, which also reduces coughing efficiency and sputum removal, providing conditions for further infection. Over time, the vicious circle expands further, aggravating the condition and making it difficult to cure. The child may develop a prolonged intermittent fever, copious pus sputum or hemoptysis. Further development can lead to pulmonary heart disease.
3, chronic bronchitis, emphysema, pulmonary heart disease: If pediatric bronchitis can not be completely cured, repeated attacks, it will turn into chronic bronchitis, and further will develop into emphysema, pulmonary heart disease. The child may have recurrent attacks with long-term intermittent coughing, sputum production, wheezing, exertional shortness of breath, panic, cyanosis, edema, and prolonged treatment.