Overview of the disease
Acute respiratory tract infections in infants and young children.
Coughing and wheezing are the main symptoms, which may be accompanied by fever and chills.
Mostly caused by viral and bacterial infections
Symptomatic treatments such as asthma, expectorant and anti-infection are the mainstay of treatment.
Definition
Wheezing bronchitis is a bronchial infection caused by a variety of pathogens, often secondary to upper respiratory tract infections, and is characterized by wheezing, coughing, and other symptoms, some of which may be accompanied by bronchial asthma.
Due to the fact that the respiratory and immune systems of the pediatric population are not yet developed, the incidence of wheezing bronchitis is higher in infants and young children [1].
Morbidity
Wheezing bronchitis can accompany many of the respiratory infections that occur in children, and its duration is generally long.
Clinical data suggest that approximately 34% of children present with at least 3 episodes of wheezing before the age of 3 weeks, and nearly 50% will present with at least 1 episode of wheezing before the age of 6 years.
The long duration of wheezing bronchitis can last for months and often causes epidemic episodes [2].
Questions you may be concerned about
What is the difference between wheezing bronchitis and asthma?
The difference between wheezing bronchitis and asthma includes the nature of the disease, causes, symptoms, and treatment.
1. Wheezing bronchitis: belongs to the more common acute bronchitis in infancy and childhood, mostly caused by viral infections, the main symptoms of coughing, shortness of breath, wheezing, the treatment can be taken to stop coughing, phlegm and asthma, or with anti-infective treatment.
2. Asthma: a heterogeneous disease characterized by chronic airway inflammation and airway hyperresponsiveness, the etiology of which is mostly related to genetic factors, environmental factors (e.g., allergenic factors, non-allergenic factors), etc., the symptoms of expiratory dyspnea with a rumbling sound, characterized by episodes or exacerbations at night and in the early hours of the morning.
Treatment of the acute stage take albuterol and terbutaline inhalation, intravenous application of glucocorticoids, theophyllines, chronic remission can take the application of inhaled glucocorticoids, leukotriene modulators, small doses of theophyllines, and so on.
Individuals can not judge between the above two, it is recommended to seek medical attention through the physician examination to clarify the condition, in order to more accurate treatment, do not self-medication, to avoid delays in the condition.
Causes
Causes
The cause of wheezing bronchitis is not yet clear, and is generally believed to be related to a variety of viral and/or bacterial infections.
The more common ones are respiratory syncytial virus, parainfluenza virus, influenza virus, coronavirus, adenovirus, rhinovirus and Mycoplasma pneumoniae. In some cases, bacterial infections may complicate viral infections, with Streptococcus pneumoniae infections being more common [3].
It may also be associated with genetic and environmental factors and is prone to recurrence [4].
Predisposing factors
Immunocompromise, allergy, nutritional disorders, rickets and bronchial structural abnormalities are all predisposing factors for this disease.
Pathogenesis
The pathogenesis mainly includes inflammatory response, airway hyperresponsiveness, and bronchial stenosis [5].
When pathogens such as viruses and bacteria invade the upper airways, inflammatory cells in the airways are activated, releasing inflammatory mediators such as interleukin-13, interleukin-4, leukotrienes, and histamine, which promotes the continuation and exacerbation of inflammatory responses in the airways [5].
The airways show excessive contractile responses to the above stimulating factors, promoting contraction of bronchial smooth muscle and causing bronchospasm and stenosis.
Bronchial cilia dysfunction leads to the manifestations of cough, sputum and wheezing.
As the disease progresses, peripheral airway occlusion, further destruction of lung parenchyma, abnormal distribution of pulmonary vascular blood flow and other factors reduce pulmonary gas exchange capacity, which can eventually lead to hypoxemia.
Long-term chronic hypoxia can lead to fibrosis and occlusion of pulmonary vessels, causing structural reorganization of the pulmonary circulation.
Symptoms
Most of them start with symptoms of upper respiratory tract infection, such as nasal congestion, runny nose, sneezing, sore throat, etc., followed by coughing and wheezing as the main symptoms. Symptoms are more severe in infants and young children. Fever, vomiting and diarrhea are often present.
Main Symptoms
Cough and sputum
Dry cough at first, then sputum, which may be white or yellow.
Wheezing
It may be characterized by fast breathing, flaring of the nose, shortness of breath, prolonged expiration time, or even dyspnea.
Fever
Medium-low fever is common, usually not more than 38℃.
Other symptoms
Irritability, vomiting, diarrhea, decreased appetite and other discomforts may also occur.
The above symptoms often last for 1~3 weeks, and the duration of symptoms may vary depending on the patient’s condition and physical condition.
Complications
For those with a history of eczema or other allergies, bronchial asthma may develop in a few cases.
Shortness of breath, wheezing and dyspnea may occur.
Consultation
Department of Medicine
Pediatrics
Infants under one month of age with coughing, wheezing, fever, loss of appetite, etc. should consult the neonatology department; children of other ages should consult the pediatrics department.
Respiratory Medicine
For patients with discomfort mainly due to cough, phlegm, wheezing, fever, etc., they may also visit the Respiratory Medicine Department.
Emergency Department
In case of emergency such as shortness of breath, difficulty in breathing, severe vomiting, diarrhea, etc., you can go to the Emergency Department or call the “120” emergency number in time.
Preparation
Information on how to get to the emergency room: registration, preparation of documents, and frequently asked questions.
Tips for medical treatment
As children are generally too young to accurately express their discomfort, parents should pay attention to observation and keep detailed records of the child’s behavior, duration, and changes in condition, as well as observe the child’s mental state, feeding, and urination and defecation, for the physician’s reference when making a diagnosis.
Preparation List
Symptom list
Does the child have symptoms such as nasal congestion, runny nose, sore throat, etc.?
Does the child have symptoms such as coughing and wheezing, and how long have they lasted?
Does the child have symptoms such as irritability, vomiting, diarrhea, decreased feeding?
Medical History Checklist
Was the child born prematurely?
Does the child have any other medical conditions such as congenital tracheal dysplasia, immunodeficiency diseases, etc.?
Has the child been exposed to patients with respiratory infections?
Is the child allergic to anything?
Diagnosis
Diagnosis is based on
Medical history
The child was born prematurely.
The child has a history of congenital tracheal dysplasia and immunodeficiency.
The child has a history of close contact with patients with respiratory tract infections.
Clinical manifestations
Symptoms
The disease is usually acute, with a short onset and rapid progression.
It is usually accompanied by symptoms of upper respiratory tract infection such as sore throat and nasal congestion.
There is often an irritating dry cough, or a small amount of mucus sputum, sputum is mostly white, or yellow sputum, coughing and wheezing at night or early in the morning when crying, whistling sounds can be heard, and in severe cases, respiratory distress can occur.
It may be accompanied by fever, chills, headache and body aches.
Physical signs
Shallow and rapid respiration, respiratory rate of 60~80 respirations/min, even 100 respirations/min, accompanied by nasal fluttering and triple concavity sign (obvious concavity of the suprasternal fossa, supraclavicular fossa, and intercostal space) [5].
The child’s heart rate is accelerated, up to 150-200 beats/min.
Body temperature may be elevated, usually not exceeding 38°C.
Lungs may be hyperlucent to percussion, and auscultation is mainly characterized by coarse breath sounds in both lungs, and scattered dry and wet rales may be heard.
Laboratory tests
Blood tests
Routine blood tests show no increase in white blood cell count in viral infections and a relatively mild increase in lymphocytes, while the total number of white blood cells and the proportion of neutrophils are elevated in bacterial infections.
Blood sedimentation, C-reactive protein, and calcitonin are often elevated in the presence of bacterial infection.
Pathogen examination
Sputum smear or sputum culture, serologic examination can sometimes detect pathogens that cause disease. They are important for guiding anti-infection treatment.
Specific antibody tests, such as mycoplasma antibody and specific virus antibody, are helpful in clarifying the diagnosis and guiding treatment.
Blood gas analysis
Blood gas analysis provides information about the degree of hypoxia and carbon dioxide retention in the child.
The reference range of partial pressure of oxygen (PO2) is 10.64-13.3kpa (80-100mmHg), below 60mmHg there is respiratory failure, and below 30mmHg there is often a danger to life.
The reference range for partial pressure of carbon dioxide (PCO2) is 4.65-5.98kPa (35-45mmHg), and exceeding or falling below the reference value is known as hyper- or hypocapnia.
It is important in determining the severity of the disease, including the severity of airflow limitation, the health status of the patient and the degree of risk of future acute exacerbations.
Imaging
Chest X-ray shows increased or normal lung texture, and chest CT may be required if necessary.
Differential Diagnosis
Based on the fact that the disease is prevalent in infants and young children, often with prodromal symptoms of upper respiratory tract infections with dry cough, wheezing and other discomforts, the diagnosis is not difficult in general, but it must be differentiated from bronchial asthma, whooping cough, and tracheal and bronchial foreign bodies.
Bronchial asthma
Similarities: Cough, wheezing, dyspnea and other discomforts.
Differences: Bronchial asthma patients usually do not have fever, runny nose, sneezing and other symptoms, and most have a family history of the disease. Symptoms, medical history, and pathogenetic testing can be used to differentiate.
Pertussis
Similarities: Both are characterized by paroxysmal coughing.
Differences: children with pertussis do not have obvious wheezing, coughing is obvious at night, and leukocytes are often elevated in the blood, and pathogenetic testing can help to identify the disease.
Tracheal and bronchial foreign bodies
Similarities: Cough, dyspnea and stridor on expiration are seen.
Differences: Tracheal and bronchial foreign bodies may present with symptoms of asphyxia or a history of inhalation, the rales are often monotonous and restricted, and there is no fever.
Treatment
Treatment aims: relief of symptoms, improvement of exercise tolerance and health status; reduction of future risks, including prevention of disease progression, prevention and treatment of acute exacerbations and reduction of morbidity and mortality [6].
Treatment principles: in mild cases, the symptoms can be relieved by themselves, and close attention should be paid to the changes of the disease; in moderate and severe cases, patients can be given treatment such as relieving cough, calming asthma and anti-infection.
General treatment
Oxygen therapy
If the oxygen saturation of the child is lower than 88% during sleep, or lower than 90% during wakefulness, the child needs to inhale oxygen.
Oxygen can be administered by nasal cannula or mask.
Children with chronic underlying cardiopulmonary disease need more active oxygen.
Ensure adequate hydration and nutritional supply
Due to elevated body temperature and rapid respiratory rate, children lose more water and need to be actively hydrated.
For children who are prone to choking, nutritional intake through nasogastric tube can be considered, and intravenous nutrition can be given if necessary.
Avoid allergens
Try to avoid contact with both identified allergens and possible allergens such as pollen, paint, and rubber items.
Medication
When using medication for infants and young children, the doctor will choose the right form and exact dosage for the age of the child, so parents should not give medication to their children on their own.
Medications are used to prevent and control symptoms, reduce the frequency and severity of acute exacerbations, and improve exercise tolerance and quality of life.
Medications include bronchodilators, hormones, expectorants, and antibiotics.
Bronchodilators
Commonly used drugs include: inhaled β2 agonists (such as salbutamol), M receptor blockers (such as ipratropium bromide).
Drug effects: can relax the bronchial smooth muscle, dilate the bronchial tubes, relieve airflow limitation.
Short-term on-demand application can relieve symptoms, long-term regular application can prevent and reduce symptoms and increase exercise tolerance.
Hormones
Commonly used medications include inhaled budesonide.
Routine treatment with systemic glucocorticoids is usually not recommended, and oral methylprednisolone tablets or intravenous methylprednisolone may be applied for severe wheezing [7].
Drug effects: Wheezing bronchitis has the potential for chronicity, and long-term regular inhaled hormones are indicated for patients with suspected bronchial asthma who have recurrent episodes of wheezing symptoms.
Medication precautions: Inhaled hormones are more effective in combination with beta2 agonists than alone.
Expectorants
Such as Ambroxol hydrochloride, acetylcysteine and so on.
Applicable to patients who are not easy to cough up mucous phlegm. It can effectively shorten the time of disappearance of clinical symptoms and signs and promote the recovery of patients [8].
Antiviral drugs
Antiviral drugs are not routinely recommended for routine use, but drugs such as oseltamivir can be used for children with clear or highly suggestive influenza virus infection.
Antimicrobials
Antimicrobials may be considered if the child has a definite co-infection with a bacterial infection.
Commonly used drugs include roxithromycin and cefixime.
Other drugs
Such as montelukast sodium and theophylline are effective in the treatment of wheezing bronchitis.
Questions you may be concerned about
How to treat wheezing bronchitis
Wheezing bronchitis is a relatively common infectious disease of the lower respiratory tract, patients can be relieved by general treatment, medication and other ways.
1. General treatment: when the patient’s oxygen saturation is persistently lower than 88% during sleep or lower than 90% during wakefulness, the patient can be given oxygen therapy, the patient should also keep the airway open, pay attention to rest, and appropriately increase the amount of water.
2. Drug therapy: for patients with respiratory syncytial virus infection, anti-viral drugs such as ribavirin can be used for anti-infection treatment; antibiotics are not routinely used in the treatment of wheezing bronchitis, but combined with or secondary to bacterial infections can be applied to amoxicillin, cephalosporin, and other antibiotics; in addition, terbutaline, budesonide, and other medications to relieve the symptoms of wheezing, and so on.
It is recommended that patients strictly follow the doctor’s instructions for medication, actively cooperate with the doctor’s treatment, pay attention to rest in life, ensure adequate sleep, maintain a happy mood, avoid overwork or tension, excitement and other adverse emotional stimuli, in addition, patients should also pay attention to monitoring the condition, regular review.
Proprietary Chinese medicines for the treatment of asthmatic bronchitis
Wheezing bronchitis belongs to the category of “cough” in traditional Chinese medicine, which is a disease in which six external evils invade the lung system, causing the lungs to lose declination, and the lung qi goes upward, making coughs or accompanied by coughing up phlegm as the main manifestation of the disease. According to the traditional Chinese medicine, we can choose Heat Inflammation Ning Granules, Lung Force Cough Compound and other proprietary Chinese medicines to treat the disease.
1. Heat Inflammation Ning Granules: the main ingredients are dandelion, tiger stick, northern septic sauce, etc., with the effect of clearing away heat and detoxifying the toxin. It is used for wind-heat cold, fever, sore throat, bitter mouth and dry throat, yellow cough and sputum, yellow urine and stool due to external wind-heat and internal depression and fire; purulent tonsillitis, acute pharyngitis, simple pneumonia with the above symptoms. Occasional gastrointestinal discomfort has been reported after taking this drug.
2. Lung Li Cough Compound: Its main ingredients include Scutellaria baicalensis, Radix Scutellariae, Radix et Rhizoma Pinelliae, etc. It has the effect of clearing heat and removing toxins, suppressing cough and expectorating phlegm, and is used for children with yellow cough and phlegm caused by phlegm-heat in the lungs, bronchial asthma, and those with bronchitis with the above mentioned symptoms. Spleen deficiency prone to diarrhea should be taken with caution.
Patients with wheezing bronchitis should go to the hospital, follow the doctor’s instructions for medication, do not self-medication, in order to avoid adverse reactions.
What is the best medicine for wheezing bronchitis?
Wheezing bronchitis treatment drugs include anti-infective drugs, cough expectorant drugs, asthma drugs, etc. It is recommended to use drugs under the guidance of a doctor, and the drug program is different in different cases.
1. Anti-infective drugs: For patients with wheezing bronchitis, the infection should be actively controlled, according to the experience of the use of drugs, such as levofloxacin, roxithromycin, cefuroxime, etc., if the culture of the causative organisms, according to the results of the sensitivity of the choice of sensitive antibiotics.
2. Cough suppressing and expectorant: If the patient coughs and has no sputum, dextromethorphan can be chosen to suppress cough. If there is phlegm and the phlegm is thick and not easy to cough out, bromhexine or aminobromine can be given to resolve the phlegm.
3. Asthma-relieving medication: asthma-relieving medication, such as bronchodilator aminophylline, or beta agonists, such as salbutamol, can be given.
Patients with asthmatic bronchitis should actively cooperate with the doctor’s treatment, do not self-medication, in order to avoid delay or adverse reactions. The above drugs need to be standardized and rationally applied under the guidance of professional physicians and pharmacists.
Prognosis
Cured
Untreated
Untreated, very few patients may recover spontaneously.
May cause death, mostly occurring in children younger than 6 months of age and in children with comorbid cardiopulmonary disease [9].
Children with wheezing bronchitis have an increased risk of developing asthma, pneumonia, and other lung diseases after middle age [10].
After treatment
With standardized treatment, most children with wheezing bronchitis recover completely, even without sequelae.
Hazards
Children often suffer from nasal congestion, runny nose, cough, fever and other symptoms, affecting their sleep and life.
In severe cases, children may experience wheezing, dyspnea, or even cyanosis, which can be life-threatening.
Daily
Daily management
Daily management
Try to maintain suitable humidity in the room to keep the respiratory tract moist, which helps to relieve coughing and wheezing and helps to expel phlegm.
Keep indoor air clean and open windows frequently for ventilation.
Close contacts of respiratory tract infections may be infected, so pay attention to respiratory isolation, such as wearing masks and avoiding crowded places.
Dietary management
Children who have added complementary food or normal diet should have a light diet, avoiding spicy and irritating foods such as chili peppers and peppercorns.
For children who have poor appetite or have difficulty in eating, small meals can be taken in the form of multiple meals.
Children with fever and cough will increase the consumption of water, so make sure to consume enough water.
Avoid eating while the child is coughing to avoid aspiration.
If the child is able to breastfeed normally, it is recommended to continue breastfeeding.
Psychological care
Children may become irritable and anxious during an attack, so it is best for parents to comfort them and give them a sense of security.
Parents can sing songs, play games, play children’s programs and other activities to relax the child’s spirit and reduce the adverse emotions.
Disease monitoring
Monitor the child’s temperature, mental status, and food intake.
If the child has cough, wheezing, fever, etc. that do not go away, or if he/she has difficulty breathing, consult a doctor.
Prevention
Wheezing bronchitis cannot be completely prevented, but the following measures can reduce the risk of the disease.
Prevent colds by adding or removing clothing and wearing masks during cold weather or seasonal changes.
Avoid taking infants and children to crowded public places with poor air circulation during the peak season for upper respiratory tract infections.
Promote breastfeeding to enhance the physical fitness of infants and young children.
Vaccination against influenza and pneumonia, if necessary, can reduce the risk of infection and help prevent wheezing bronchitis.