OVERVIEW
Wheezing bronchopneumonia is a clinical syndrome that generalizes to a group of acute bronchopneumonias in infants and children with wheezing manifestations. Some children may develop bronchial asthma.
Causes
1. Infectious factors
A variety of viral and bacterial infections can cause. The more common ones are respiratory syncytial virus, influenza virus, parainfluenza virus, adenovirus, rhinovirus and Mycoplasma pneumoniae, etc. In some cases, bacterial infection may be complicated on the basis of viral infection.
2. Allergic factors
Most of the children have allergic tendency, that is, the children or relatives have eczema, food or drug allergy, allergic rhinitis, urticaria, bronchial asthma and other allergic diseases.
3. Anatomical characteristics
The trachea and bronchial tubes of infants and young children are narrow, the elastic fibers around them are not well developed, and the mucous membranes are susceptible to infections or other stimuli, which may cause swelling and congestion and lead to narrowing of the tubes, and the secretions are thick and sticky and not easy to be coughed up, which results in wheezing sounds.
Symptoms
1. The age of onset is relatively young, mostly seen in children aged 1 to 3 years old.
2. Often secondary to upper respiratory tract infection. Most have low to moderate fever. Prolonged expiratory time, accompanied by rales and coarse wet rales, wheezing without obvious episodes.
3. After treatment, the symptoms are reduced in 5-7 days.
4. Some cases may have recurrence, mostly due to re-infection.
Examination
1. X-ray examination
Infiltrating shadows in the lungs in various forms, with segmental distribution, mostly in the lower lung fields.
2. Blood tests
In viral infection, the total number of leukocytes and neutrophils are usually decreased, while in bacterial infection, they are increased. In mycoplasma infection or mixed infection, blood tests are not specific.
3. Specific antibody test
Specific antibody test, such as mycoplasma antibody, specific virus antibody, etc., can be improved when necessary, which is helpful for the rational use of antibiotics, treatment course and prognosis judgment.
Diagnosis
In general, the diagnosis of wheezing bronchopneumonia can be made based on the clinical manifestations and signs of the patient, combined with chest X-ray and other examinations.
In 1988, the National Conference on Pediatric Asthma put forward the diagnostic criteria (scoring method) for evaluating asthma in infants and young children, and the scoring principle for those who have recurrent episodes of wheezing at the age of <3 years:
1. 2 points for recurrent wheezing episodes ≥3 times in infants and young children with capillary bronchitis or wheeze-like bronchitis.
2. 2 points for the presence of rales in the lungs.
3. 1 point for sudden onset of wheezing symptoms.
4. 1 point for a history of other allergies in the child.
5. 1 point if there is a history of eczema, dermatitis or asthma in the first or second degree relatives.
If the total score of the above > 5 points, the diagnosis of asthma wheezing attack in infants and children, only 2 times or the total score of ≤ 4 points, the initial diagnosis of wheezing bronchitis, and continue to follow up the observation.
Treatment
1. General treatment pay attention to rest. Infants should be patted on the back and changed position frequently to promote the discharge of respiratory secretions. Severe cases should refer to the treatment of capillary bronchitis and bronchial asthma.2. Anti-infective treatment of bacterial infections empirical medication, usually choose penicillin or cephalosporin antibiotics, oral or intravenous drip. Consider mycoplasma infection preferred macrolide antibiotics. Simple viral infections may not require antibiotics. Adjust the medication according to the clinical and laboratory results.3. Symptomatic treatment of fever with physical and drug cooling to prevent hyperthermia and convulsions; the use of bronchodilator nebulizer inhalation, relief of cough and wheezing, to promote the excretion of phlegm; oral cough medication. Severe cases are treated according to the bronchial asthma attack.4. Chinese medicine treatment of this disease is called exogenous cough, due to the different causative factors, clinically categorized into wind-cold cough, wind-heat cough and real-heat asthma. The treatment is based on dispersing wind and cold, clearing heat and promoting the lungs, reducing heat and calming asthma, which can be combined with clinical diagnosis and treatment.
Questions you may be concerned about
How to treat wheezing bronchopneumonia
The treatment of asthmatic bronchopneumonia mainly includes general treatment, drug treatment, etc. The details are as follows:
1. General treatment: patients should pay attention to rest, family members can help patients pat the back to promote the discharge of respiratory secretions, but also should avoid inhaling harmful gases, dust and smoke and other irritating substances.
2. Drug treatment:
(1) Choose antibacterial drugs according to the presence of bacterial infection, such as ceftriaxone, cefoperazone, etc.; the presence of mycoplasma infection, choose macrolides, such as azithromycin; the presence of viral infection, choose antiviral drugs, such as oseltamivir;
(2) Symptomatic treatment, the use of bronchodilators such as salbutamol, terbutaline, ipratropium bromide, aminophylline, etc., can relax the smooth muscle, dilate the bronchial tubes, and alleviate the symptoms; you can also use expectorants such as aminoglutethimide, bromhexine and so on.
All of the above medications should be used under the guidance of a doctor.
When wheezing bronchitis occurs, you should go to the hospital in time and follow the doctor’s instructions for early treatment.