Recently, many patients have been coughing repeatedly after catching a cold and going to the hospital for examination usually results in a diagnosis of bronchitis, but parents still do not understand bronchitis, is bronchitis curable? Is bronchitis as troublesome as chronic bronchitis in the elderly? What care is needed to make the recovery faster and better? I have summarized my own treatment experience to share with parents in the hope that it will help their children grow up healthily and ease the anxiety and worry of some parents.
I. Diagnostic points
Clinical diagnosis
1. Age: The disease can develop at all ages during childhood.
2. Respiratory symptoms: Most of them have symptoms of upper respiratory tract infection first. Cough is the main symptom, starting with a dry cough and later with sputum. The onset of the disease may be acute or slow, and the fever may be high or low. Sometimes it may be accompanied by wheezing.
Accompanying symptoms: Infants and children have more obvious systemic symptoms, often with fever, and may be accompanied by vomiting, diarrhea and other gastrointestinal symptoms; older children have milder systemic symptoms, often with headache, chest pain, coughing mucous sputum or pus sputum.
3. Pulmonary signs: coarse breath sounds in both lungs, sometimes irregular, scattered dry rales and coarse
4.Other signs: Nasal symptoms such as nasal congestion, runny nose, pus, headache, etc. may be associated with the combination of paranasal sinusitis. There are corresponding signs when there are other system complications.
Auxiliary tests
1.Blood routine: total white blood cell count and classification are mostly in the normal range, if there is an increase, it indicates secondary bacterial infection.
2, CRP: normal, but may increase when combined with bacterial infection.
3.Chest X-ray: thickened texture of both lungs and thickened shadow of the lung door.
4.Blood gas analysis: generally normal.
5, pathogenic examination: mostly caused by viruses, but also bacterial infections or mixed infections. Other pathogens are mycoplasma, chlamydia, etc.
6.Lung function: generally normal.
7.Indication of CT examination: poor efficacy by conventional treatment, need to exclude tracheobronchial foreign body, lymph node enlargement, mediastinal occupancy, or recurrent wheezing need to exclude congenital malformation, etc.
Understand clinical special types
Chronic bronchitis: duration of disease more than 2 years, with episodes lasting more than 2 months per year.
Asthmatic bronchitis or asthmatic bronchitis (asthmatic bronchitis): refers to bronchitis in infants and children with wheezing, a diagnosis that has now been abolished. In general, bronchitis can be diagnosed in older children if they have a first episode and the condition is mild, while capillary bronchitis or viral pneumonia can be diagnosed in infants or those with severe wheezing. Bronchial asthma should be considered in the presence of atopic constitution (eczema or allergic rhinitis) or family history of asthma, and this diagnosis is supported if anti-asthmatic treatment is effective.
Cast bronchitis: chest CT helps in the diagnosis.
Paranasal sinus bronchitis: CT of the paranasal sinuses and chest helps to make the diagnosis.
Occlusive fine bronchitis: CT of the chest helps in the diagnosis (mosaic sign).
Understanding the risk factors for recurrent bronchiectasis
1. Small infants, premature babies.
2.Polluted living environment, passive smokers.
3.Persons with allergies, airway hyperreactivity.
4.Persons with primary diseases such as bronchial foreign body aspiration, bronchiectasis
5.Patients with underlying diseases such as BPD, congenital heart disease or immunocompromised or immunodeficient.
Differential diagnosis
1.Acute upper respiratory tract infection: nasopharyngeal symptoms are the main symptoms, often without cough and sputum, and no abnormal signs in the lungs, but if not treated properly, it can develop into acute tracheobronchitis.
2, early acute infectious diseases: such as measles, whooping cough, scarlet fever, etc., early performance can have similar symptoms.
3, pneumonia: infants and young children with more severe bronchitis is difficult to should be distinguished from early pneumonia, the lungs can be smelled fixed in the fine wet stalls in the middle of the Huanzhi people’s hospital gala WeiXi brother ÌÎÌ_ÌÎÌ_ÌÎÌ_ÌÎÌ_ÌÎÌ_ÌÎÌ_ÌÎÌ_ÌÎÌ_ÌÎÌ_ÌÎÌ_ÌÎÌ_ÌÎÌ_ÌÎÌ_ÌÎÌ_ÌÎÌ_ÌÎÌ_ÌÎÌ_ÌÎÌ_ÌÎÌ_ÌÎå
4.Pulmonary hilar lymph node tuberculosis: cough or wheezing is often caused by compression of enlarged lymph nodes. There is often a history of contact with TB patients and obvious symptoms of TB toxicity (low-grade fever, malaise, night sweats, wasting), and PPD, chest X-ray and sputum examination can help confirm the diagnosis.
5. The recurrent patients should be differentiated from cough variant asthma, foreign body aspiration, congenital airway malformation, gastroesophageal reflux, bronchiectasis, selective IgA deficiency, etc.
II. Treatment
Parental education
1. Explain the basic knowledge and clinical course of bronchiectasis.
2.Disseminate appropriate techniques for postural drainage and keeping the airway open.
3.Inform the manifestations of progression or deterioration and possible complications.
Monitoring
1.Chest X-ray, PPD, immune function test and allergen test should be performed in the acute stage if available.
2.In severe cases, blood gas analysis should be given to observe the changes of partial pressure of oxygen and partial pressure of carbon dioxide.
Oxygen therapy and keep the respiratory tract unobstructed
1.Pay attention to rest, light diet, change position frequently, drink more boiled water and increase air humidity.
2. Generally, oxygen is not needed, but if necessary, oxygen can be administered by modified nasal catheter with an oxygen flow rate of 1-2L/min for critically ill children and infants less than 3 months old.
3.Respiratory nebulizer inhalation treatment can be used (see nebulizer inhalation for specific drug selection and dosage), patting the back and aspirating sputum after inhalation to promote the discharge of secretions.
Rehydration and nutritional support
1. If the child loses water due to little food and shortness of breath, intravenous or oral rehydration fluid can be used. Generally, 4:1 fluid is used to supplement 60-80ml/Kg according to physiological needs.
2.For children with recurrent bronchitis, children with poor nutrition and very little food can increase nutritional intake or give intravenous nutrition.
Drug treatment
1.Anti-viral: There is no special drug. Can choose ribavirin 10mg/Kg intravenous drip, the early onset of the drug may be effective, but easy to lead to granulocyte reduction and hemolytic anemia; also can choose to inflammatory aspirin injection 8mg/ Kg intravenous drip.
2, antibacterial therapy: such as less than 3 months infants, the duration of the disease more than 1 week, clinical signs of bacterial infection, can be used as appropriate, generally with one or two generations of cephalosporins, suspected mycoplasma infection oral azithromycin.
3, expectorant cough treatment: mild cough without cough medicine, so as not to affect the sputum excretion. For thick sputum, you can use expectorants containing guaiac glycerol ether such as (benzoin, Aishu); mucinolytic agents such as acetylcysteine (Fulusi); promote the effect of sputum excretion such as aminoglutethimide (Mucosolvan); mucus thinning agent (Ginoton), etc. For dry coughs, dextromethorphan-containing drugs such as Cengong Huafen or Chinese herbal medicine such as snake bile and Chuanbei loquat. Those with severe cough that affects rest can use compound codeine (federal cough syrup), compound forcodine solution, etc. for a short period of time. For allergic coughs, antihistamines such as chlorpheniramine maleate and fexofenadine syrup can be used. However, it should be noted that infants and children should be mainly expectorant and cough medicines should be used with caution.
4, other symptomatic treatment: those with diarrhea are given drugs to regulate intestinal flora. Those with abnormal liver function should be given liver-protective treatment. Those who are irritable should be given appropriate sedation. If you have high fever, give antipyretic.
5.Hormone therapy: If there is wheezing, surface corticosteroids (such as pramipexole) can be used for nebulized inhalation. It is not recommended to use intravenous hormone routinely, and the heavy cases can be treated with prednisone tablets 1mg/kg/d orally for 1-3 days. If the symptoms of poisoning are heavy and wheezing is obvious, dexamethasone or methylprednisolone injection can be used as appropriate.
6, bronchodilators: not routinely used, if wheezing is serious can use nebulized inhalation salbutamol or Boliconi solution as appropriate, if the child after the administration of clinical condition improvement, can be considered to continue to use. Oral administration of Boliconi (0.1mg/kg/dose, tid), Meprobamate (1ug/kg/dose, q12h), Bambuterol (help preparation) is also available.
7.Supportive treatment: Children of young age or those with prolonged disease can be treated with intravenous propecia or plasma support as appropriate.
8.If the child’s condition is progressively aggravated after the above treatment, attention should be paid to the differential diagnosis, and generally there is no indication for transfer to ICU.
Family care
General measures to prevent respiratory tract infection
1.Avoid exposure to smoking environment
2. Try not to go to public places during the epidemic season of viral respiratory infections.
3. Emphasis should be placed on frequent hand washing.