What are the dangers of bronchitis in children?

Pediatric bronchitis refers to inflammation of the bronchi. The lesions of pediatric bronchiolitis mainly occur in the small bronchi of the lungs, that is, the capillaries, so the disease is called "bronchiolitis". It is usually caused by the common cold. , complications caused by viral infections such as influenza, may also be caused by bacterial infections, and is a common acute upper respiratory tract infection in children. Bronchitis in children is called "bronchiolitis". The main cause of bronchiolitis is respiratory syncytial virus, which can account for 80% or more; others are adenovirus, parainfluenza virus, rhinovirus, influenza virus, etc.; a few cases can be caused by Mycoplasma pneumoniae. After infection with the virus, tiny Capillary congestion, edema, increased mucus secretion, and necrotic mucosal epithelial cells shed and block the lumen, leading to obvious emphysema and atelectasis. Pneumonia can usually involve alveoli, alveolar walls and pulmonary interstitium, so it can be considered a special type of pneumonia.

Bronchiolitis is different from general tracheitis or bronchitis. The clinical symptoms are like pneumonia, but mainly wheezing. This disease mostly occurs in children under 2.5 years old, and 80% of them are under 1 year old. , mostly children under 6 months old. Typical bronchiolitis often occurs 2 to 3 days after upper respiratory tract infection. Persistent dry cough and fever appear. The body temperature is usually moderate to low fever. It is characterized by episodes of wheezing and suffocation. The condition begins 2 days after the onset of wheezing and suffocation. It was more serious on the 3rd day. During the asthma attack, breathing increased significantly, reaching more than 60 to 80 times per minute, accompanied by prolonged expiration and Hohhot airway wheezing. Children with severe symptoms obviously showed nasal congestion and "three concave signs." "(that is, the supraclavicular fossa, suprasternal fossa and upper abdominal depression appear when inhaling), the face is pale, the perioral area is bluish, or cyanosis occurs. Children are often restless and moaning; children with more severe conditions may be complicated by heart failure or Respiratory failure can be relieved in most cases after treatment, and death rarely occurs.

Children should be sent to the hospital for treatment promptly after becoming ill. Since bronchiolitis is mostly caused by viral infection, antibiotic treatment is generally not required in the early stages of the disease. If secondary bacterial infection is suspected in the later stages of the disease, antibiotics can be used for treatment. The treatment is mainly symptomatic, which can be summarized as "sedation and coughing." In addition, good nursing care is also very important. Pay special attention not to disturb the child and allow him to rest quietly, indoors. It is necessary to maintain a certain humidity. Severely ill children can cooperate with atomization inhalation and timely suction to keep the respiratory tract open. They can also be treated with traditional Chinese medicine.

The prognosis of bronchiolitis is usually good, and the course of the disease is generally 5 to 9 days. However, it should be noted that children who have suffered from bronchiolitis are prone to asthma in the future. Through the national epidemiological survey of childhood asthma and the follow-up of infants and young children with bronchiolitis, it was found that 20% to 40% of them suffer from asthma. Children will develop childhood asthma in the future. Therefore, bronchiolitis must be actively prevented and treated to reduce the occurrence of asthma.

Bronchiolitis can sometimes cause epidemics. In the 1970s, there were three epidemics in the rural areas of southern my country. In the 1980s, it was popular in Yuncheng, Shanxi Province. In the 1990s, it was popular in Beijing and Tianjin. In the early 1970s, it was popular in When the disease was prevalent in the South, there was still a lack of understanding of the disease. At that time, the disease had different names and the cause was unknown. Later, after the Ministry of Health organized a nationwide collaboration to monitor and research the epidemic, it was named "epidemic asthma-suffocation pneumonia". In order to determine the cause, After years of research, medical researchers finally successfully isolated the respiratory syncytial virus, the causative agent of epidemic asthma-suffocating pneumonia, in 1997, and identified the prevalent pathogen as respiratory syncytial virus subtype A, which will be helpful for the future production of effective vaccines. , the prevention of capillary bronchiectasis provides an important basis for the epidemic.

(1) It is more common in children under 1 year old, especially in infants under 6 months old.

(2) It can occur throughout the year, but is more common in winter and spring.

(3) The onset of the disease is rapid, with pre-cold symptoms such as coughing and sneezing. The coughing worsens after 1 to 2 days, with episodic dyspnea, wheezing, pale complexion, cyanosis of the lips, and three concave signs. , the early pulmonary signs are mainly stridor, followed by crackles. Severe symptoms may be accompanied by congestive heart failure, respiratory failure, hypoxic encephalopathy, and fluid and electrolyte imbalances. Generally, the body temperature does not exceed 38.5℃, and the duration of the disease is 1 to 2 weeks.

(4) The number of white blood cells in the blood is normal or slightly increased. Blood gas analysis shows hypoxemia and a decrease or increase in the partial pressure of carbon dioxide in the arterial blood. Chest X-ray shows thickened lung texture, enhanced translucency of both lungs, or small shadows and atelectasis. If conditions permit, rapid virus diagnosis in respiratory secretions can be done to clarify the type of virus.

Frequent and deep dry cough occurs, and later bronchial secretions gradually appear. Infants and young children do not expectorate and mostly swallow through the pharynx. Those with mild symptoms have no obvious illness, while those with severe symptoms have a fever of 38 to 39°C, occasionally reaching 40°C, which usually subsides in 2 to 3 days. Feeling tired, affecting sleep and appetite, and even causing gastrointestinal symptoms such as vomiting, diarrhea, and abdominal pain. The older child complained of headache and chest pain again. Cough usually lasts for 7 to 10 days, sometimes 2 to 3 weeks, or relapses. If it is not treated appropriately, it can cause pneumonia. White blood cells are normal or slightly low. Those with elevated white blood cells may have secondary bacterial infections.

Complications are rare in healthy children, but children with malnutrition, low immune function, congenital respiratory malformations, chronic nasopharyngitis, rickets, etc. are not only susceptible to bronchitis, but also prone to pneumonia and otitis media. , laryngitis and paranasal sinusitis.

The cause of the disease

is mostly caused by a mixed infection of viruses and bacteria. According to epidemiological surveys, the main viruses are rhinovirus, syncytial virus, influenza virus and rubella virus. The more common bacteria are pneumococci, hemolytic streptococci, staphylococci, influenzae, Salmonella and diphtheriae. In addition, sudden changes in temperature, dirty air, anatomical and physiological characteristics of the respiratory tract in children, allergic factors, and low immune function are all causes of this disease. [1]

Home care

Bronchitis is a common respiratory disease in children with a high prevalence. It can occur throughout the year and reaches its peak in winter and spring. When suffering from bronchitis, children often have varying degrees of fever, cough, loss of appetite, or vomiting, diarrhea, etc. Younger children may also have symptoms of bronchiolitis such as wheezing and wheezing. Although a small number of children may develop bronchopneumonia, most children are mildly ill and require medication and care at home. Parents should follow the doctor's instructions to give their children medication on time and provide home care:

< p>1. Keep warm: Temperature changes, especially the stimulation of cold, can reduce the local resistance of the bronchial mucosa and aggravate the condition of bronchitis. Therefore, parents should add or remove clothing for children in time as the temperature changes, especially when sleeping. Cover the baby with a quilt to keep the body temperature above 36.5°C.

2. Feed more water: Children with bronchitis have varying degrees of fever, and water evaporates greatly. You should pay attention to giving the child more water. It can be supplemented with sugar water or sugar salt water, or rice soup or egg soup. The diet is mainly semi-liquid to increase body water and meet the body's needs.

3. Adequate nutrition: When children suffer from bronchitis, they consume a lot of nutrients. In addition, fever and bacterial toxins affect gastrointestinal function and lead to poor digestion and absorption. Therefore, nutritional deficiencies in children cannot be ignored. In this regard, parents should adopt a small and frequent meal approach for children, and provide them with a light, nutritious, balanced, semi-liquid or liquid diet that is easy to digest and absorb, such as porridge, thoroughly cooked noodles, egg custard, fresh vegetables, fruit juices, etc.

4. Turn over and pat the back: When a child coughs or expectorates, it indicates an increase in bronchial secretions. In order to promote the smooth discharge of secretions, atomized inhalants can be used to help eliminate phlegm, 2-3 times a day. 5-20 minutes each time. If it is an infant, in addition to patting on the back, the patient should also be helped to turn over once every 1-2 hours to keep the child in a semi-recumbent position to facilitate the discharge of sputum.

5. Antipyretic: Children with bronchitis usually have moderate to low fever. If the body temperature is below 38.5°C, there is generally no need to give antipyretic drugs. The main focus is to treat the cause and fundamentally solve the problem. If the body temperature is high, older children can be physically cooled, that is, using a cold towel to wet their head or bathing with warm water. However, this method should not be used for young children. If necessary, drugs should be used to cool down.

6. Maintain a good family environment: The room where the child lives should be warm, well ventilated and well lit, and there should be a certain humidity in the air to prevent excessive dryness. If there is a smoker at home, it is best to quit smoking or smoke outdoors to prevent the adverse effects of smoking on children.

Clinical diagnosis

(1) Clinical manifestations

1. At the beginning, there are fever, chills, headache, dry throat, etc.

2． The main symptoms are cough and sputum production.

(2) Main types

1. The initial stage of acute bronchitis is dry cough, and the amount of sputum gradually increases, and gradually turns into mucopurulent sputum

Pediatric Bronchitis

Pediatric Bronchitis

Sputum.

2． Chronic bronchitis is mainly characterized by persistent cough that does not heal for many months and worsens in the morning and evening, especially at night. The amount of phlegm is more or less, and coughing up is the fastest. Symptoms are mild in summer, but acute attacks are likely to occur in winter, making the condition worse. Those who suffer from repeated attacks are often thin and weak. It can be complicated by atelectasis, emphysema, bronchiectasis, etc.

(3) Physical and chemical testing

1. In the early stage, breath sounds may become thicker, and vesicular sounds may be heard bilaterally.

2． X-ray examination: There may be no special findings in acute cases. Chronic patients may have corresponding chronic inflammatory changes.

Differential diagnosis

(1) Those with mild illness must be differentiated from upper respiratory tract infection.

(2) Bronchial foreign bodies: When there is respiratory obstruction accompanied by infection, the respiratory symptoms are similar to acute tracheitis. You should pay attention to ask whether there is a history of inhalation of foreign bodies in the respiratory tract. After treatment, the curative effect is not good and the symptoms are not prolonged. Healed and relapsed. Chest X-ray examination showed obstruction such as atelectasis and emphysema.

(3) Hilar bronchial lymph node tuberculosis: based on tuberculosis contact history, tuberculin test and chest X-ray examination.

(4) Bronchiolitis: more common in infants under 6 months old, with obvious acute attacks

Pediatric bronchitis

Pediatric bronchitis

Sexual asthma and difficulty breathing. The body temperature is not high, and the rales in the lungs are not obvious during the asthma attack, but fine wet rales can be heard after relief.

(5) Bronchopneumonia: When the symptoms of acute bronchitis are severe, they should be distinguished from bronchopneumonia.

Treatment methods

Infection control

If acute bronchitis is bacterial infection, the following antibacterial drugs can be used: Compound-sulfamethoxazole 0.05/kg/day divided into two Orally, penicillin 30,000-50,000 U/mg/day divided into 2 intramuscular injections, Medicimycin and erythromycin 30-50mg/kg/day orally divided into 3-4 times.

If there is no clear bacterial infection or mixed infection, Ribavirin 10-15 mg/kg/day can be administered intramuscularly in 2 divided doses, or 5 mg/kg/day divided into 2 divided doses for aerosol inhalation , you can also try α-interferon 200,000 U/day intramuscular injection.

Symptomatic treatment

1. Cough and expectorant: If the phlegm is thick and difficult to be sucked out, you can use atomized inhalation or 10% ammonium chloride mixture, Bisuping, Pediatric Strong Phlegm Ling (1-2 tablets for 2-4 years old, 2-3 tablets for 5-8 years old) ). . Frequent dry cough affects sleep and rest. You can take a small amount of antitussive drugs, such as promethazine and chlorpromazine 0.5-1mg/kg/time, 2-3 times a day. Care should be taken to avoid overdose and prolonged use, which may affect the growth of cilia. Physiological vitality makes secretions difficult to discharge.