Capillary bronchitis, which occurs in winter, can cause localized epidemics. The lesions of capillary bronchitis occur mainly in the tiny bronchi of the lungs, the capillary bronchi, hence the name “capillary bronchitis”, which is usually a complication of viral infections such as the common cold, influenza, or possibly bacterial infections, and is a common acute lower whistle infection in children. The pathogen of capillary bronchitis is mainly the whistle syncytial virus, which can account for 80% or more; others are adenovirus, parainfluenza virus, rhinovirus, influenza virus, etc. in that order; a few cases can be caused by Mycoplasma pneumoniae; after infection with the virus, the tiny capillary bronchial tubes become congested, edematous, and have increased mucus secretion, plus necrotic mucosal epithelial cells shed and block the lumen, resulting in 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, mostly under 6 months of age.
Epidemiological features
Capillary bronchitis can sometimes cause epidemics, in the 1970s in China’s southern rural areas have occurred three times in the epidemic, in the 1980s in Shanxi Yuncheng area, the 1990s in Beijing, Tianjin area, the early 1970s in the southern epidemic, the disease is still lack of knowledge, the disease name at that time, the etiology is unknown, and later by the Ministry of Health organized a national collaborative monitoring and research on the epidemic, the party named “In order to determine its etiology, medical researchers finally succeeded in 1997, after years of research, in isolating the etiology of epidemic asthmatic pneumonia, a whistle syncytial virus, and identified the epidemic etiology as whistle syncytial virus subtype A, which is important for the future production of an effective vaccine to prevent capillary bronchial This provides an important basis for the development of an effective vaccine to prevent the epidemic of capillary bronchitis.
Symptoms and signs
(a) The disease is most common in children under 1 year of age, especially in infants under 6 months of age.
(b) The disease can occur throughout the year, but is more common in winter and spring.
(c) 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, trismus, and early wheezing sounds followed by wet sounds in the lungs. In severe cases, the symptoms may be accompanied by congestive heart failure, whistling failure, hypoxic encephalopathy, and water and electrolyte disturbances. The general temperature does not exceed 38.5°C and the duration of the disease is 1 to 2 weeks.
(D) Blood leukocytes are mostly normal or mildly increased. Blood gas analysis shows hypoxemia as well as decreased or increased partial pressure of arterial blood carbon dioxide. Chest radiographs show thickened lung texture, increased translucency of both lungs or small shadows and pulmonary atelectasis. A rapid diagnosis of virus in the whistle secretions can be done if available to clarify the type of virus.
Clinical features
The onset of pediatric capillary bronchitis can be acute or slow. Most of them have symptoms of upper whistle 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 spit, and most swallow 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. They feel fatigue, affect their appetite for sleep, and even have gastrointestinal symptoms such as vomiting, diarrhea, and abdominal pain. 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 whistling tract malformations, chronic nasopharyngitis, and rickets, children are not only susceptible to bronchitis, but also to pneumonia, otitis media, laryngitis, and paranasal sinusitis.
Home care
Bronchitis is a common childhood respiratory disease with a high prevalence rate that can occur throughout the year, peaking 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.
The temperature change, especially the cold stimulation can reduce the local resistance of the bronchial mucosa and aggravate the bronchitis, therefore, parents should increase or decrease the clothing for the child in time with the temperature change, especially when sleeping to cover the child well, so that the body temperature is kept above 36.5 ℃.
The actual fact is that you will be able to get a lot more than just a few of the most popular and most popular items. You can use sugar water or sugar saline to supplement, also can use rice soup, egg soup to supplement. The diet is mainly semi-liquid to increase the body water to meet the needs of the body.
In this regard, parents should take a small number of meals to 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.
Fourth, turn over and pat the back: when the child coughs and coughs up sputum, it indicates an increase in bronchial secretions. To promote the smooth discharge of secretions, nebulized inhalants can be used to help expectoration, 2-3 times a day for 5-20 minutes each time. In the case of infants and young children, in addition to patting their backs, they should also be helped to turn over once every 1-2 hours to keep the children in a semi-recumbent position, which is favorable to the discharge of sputum.
If the body temperature is below 38.5℃, there is no need to give antipyretic drugs, mainly for the treatment of the cause of the disease, to solve the problem at the root. If the body temperature is high, larger 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 reduce temperature.
Sixth, maintain a good family environment: the affected children in the living room should be warm, well ventilated and well-lit, and there should be a certain amount of humidity in the air 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
(A) Clinical manifestations
1.Fever, chills, headache, and dry throat at the beginning.
2. The main symptoms are cough and sputum.
(B) Main types
1.The initial stage of acute bronchitis is dry cough, and the amount of sputum gradually increases and gradually becomes mucopurulent sputum.
2.Chronic bronchitis is mainly a persistent cough that 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.
(C) physical and chemical tests
1, early whistling sounds can be coarse, and vesicular sounds can be heard bilaterally.
2.X-ray examination: acute patients may have no special findings. Chronic cases may have corresponding chronic inflammatory changes.
Differential diagnosis
(a) The milder cases must be differentiated from upper whistle infection.
(b) Bronchial foreign body: when there is a whistle obstruction with infection, the whistle symptoms are similar to those of acute bronchitis, attention should be paid to ask whether there is a history of whistle foreign body aspiration, after treatment, the efficacy is not good, delayed and recurrent. Chest X-ray shows obstruction such as pulmonary atelectasis and emphysema.
(iii) Pulmonary hilar bronchial lymph node tuberculosis: according to the history of tuberculosis contact, tuberculin test and chest X-ray examination.
(iv) Capillary bronchitis: Most often seen in infants under 6 months of age with significant acute episodes of wheezing and inspiratory difficulties. 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
(E) Bronchopneumonia: When the symptoms of acute bronchitis are severe, it should be differentiated from bronchopneumonia.
Treatment
(a) 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 three to four oral doses. If there is no clear bacterial infection or mixed infection, use or add virazole 10-15mg/kg/day in 2 doses, or 5mg/kg/day in 2 doses for nebulized inhalation, or try a-interferon 200,000U/day intramuscular injection.
(B) 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: 2-4mg/kg/time 3-4 times/day orally. Salbutamol: 1-2mg/day in 3-4 times orally or 0.1mg/kg/time under 6 years old, and prednisone 1mg/kg/day in 3 times orally for 4-7 days if wheezing is serious.
(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 young children after the disease, long-term medication can bring some drugs toxic effects, the safety and convenience of external paste Chinese medicine is also a good way. At present, the more used are expectorant, pulling phlegm Bacchus agaricus yiqi paste and winter with the three nine paste and so on.
(D) Tui Na treatment
Through Tui-Na techniques, children with bronchitis symptoms are massaged and tui-naed at acupuncture points to unblock the breath to achieve therapeutic effects. Currently, some of the more well-known pediatric massage clinics include 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. Because of the slow excretion of sulfonamides, easy to cause crystalline precipitation in the kidneys, so during the use of drugs to supply sufficient water 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 body weight per day, divided into 3-4 times orally 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 the bronchitis does not heal repeatedly, the child should be carefully checked for congenital malformations of the bronchi, 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, inspiratory difficulties, acute whistle failure, and even complications such as pulmonary atelectasis, emphysema, pus, pneumothorax, lung abscess, pericarditis, sepsis, which can be life-threatening.
2, bronchial dilatation: When pediatric bronchitis is not properly treated, it can turn into chronic bronchial purulent inflammation, which destroys the bronchial wall so that the bronchial wall deformation and expansion, the wall tissue is destroyed, so that the bronchial tube loses its original natural defensive capabilities, but also reduces the efficiency of coughing and sputum removal function, providing the 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.