What Is Chronic Pneumonia?

Lung anatomy illustration

Chronic pneumonia

Pneumonia refers to the symptoms of inflammation of the alveoli in the lungs. Chronic pneumonia occurs in patients with a course of more than 3 months.

Overview of chronic pneumonia

Lung anatomy illustration Chinese Pinyin: màn xìng fèi yán

Chronic pneumonia occurred in patients with a course of more than 3 months. In recent years, the mortality of children with acute pneumonia is decreasing, but children with severe pneumonia sometimes do not fully recover, and it is not uncommon for patients with relapse and evolution to chronic pneumonia. Therefore, timely prevention and treatment of chronic pneumonia is very important.

Chronic pneumonia disease description

Chronic pneumonia Chronic pneumonia occurred in patients with a course of more than 3 months. In recent years, the mortality of children with acute pneumonia is decreasing, but children with severe pneumonia sometimes do not fully recover, and it is not uncommon for patients with relapse and evolution to chronic pneumonia. Therefore, timely prevention and treatment of chronic pneumonia is very important.

There are several factors contributing to chronic pneumonia: Pneumonia in children with malnutrition, rickets, congenital heart disease or tuberculosis is prone to prolong the course of the disease. Viral infection causes interstitial pneumonia, which easily evolves into chronic pneumonia. The Capital Institute of Pediatrics has followed up 103 cases of adenoviral pneumonia 1 to 5 years after the illness and found that 30.1% showed chronic pneumonia and atelectasis of varying severity on X-ray examination, and individual children had bronchiectasis. Thirteen cases of measles complicated with adenoviral pneumonia were followed up 2 to 3 years after the disease, of which 6 cases had become chronic pneumonia. Recurrent upper respiratory tract infections or bronchitis and chronic sinusitis are all causes of chronic pneumonia. Foreign bodies that penetrate into the bronchus, especially foreign bodies that lack irritation and do not produce initial acute fever (such as jujube nuclei), can be ignored and remain in the lungs for a long time, forming chronic pneumonia. Immunodeficient children, including humoral and cellular immunodeficiency, complement deficiency and leukocytic phagocytosis, can cause recurrent pneumonia and eventually become chronic. The abnormality of primary or secondary respiratory cilia morphology and function can cause chronic lung inflammation.

Inflammatory lesions can invade bronchi, alveoli, interstitial tissue, and blood vessels at all levels. Especially in the inflammation of interstitial tissue, it progresses with each attack, causing the elastic fibers of the bronchial wall to be destroyed, and the lumen narrowed due to fibrosis. At the same time, atelectasis occurs due to the clogging of the lumen by the secretions, which eventually leads to bronchiectasis. Due to the destruction of the bronchial wall and the alveolar wall, air spreads through the lymphatic vessels and enters the interstitial space, which can form interstitial emphysema. Proliferative inflammation also occurred in local blood vessels and lymphatic vessels, with thickened walls and narrowed lumen.

Etiology of chronic pneumonia

Chronic pneumonia There are several factors contributing to chronic pneumonia: Pneumonia in children with malnutrition, rickets, congenital heart disease or tuberculosis is prone to prolong the course of the disease. Viral infection causes interstitial pneumonia, which easily evolves into chronic pneumonia. The Capital Institute of Pediatrics has followed up 103 cases of adenoviral pneumonia 1 to 5 years after the illness and found that 30.1% showed chronic pneumonia and atelectasis of varying severity on X-ray examination, and individual children had bronchiectasis. Thirteen cases of measles complicated with adenoviral pneumonia were followed up 2 to 3 years after the disease, of which 6 cases had become chronic pneumonia. Recurrent upper respiratory tract infections or bronchitis and chronic sinusitis are all causes of chronic pneumonia. Foreign bodies that penetrate into the bronchus, especially foreign bodies that lack irritation and do not produce initial acute fever (such as jujube nuclei), can be ignored and remain in the lungs for a long time, forming chronic pneumonia. Immunodeficient children, including humoral and cellular immunodeficiency, complement deficiency and leukocytic phagocytosis, can cause recurrent pneumonia and eventually become chronic. The abnormality of primary or secondary respiratory cilia morphology and function can cause chronic lung inflammation.

Causes of chronic pneumonia

Under normal circumstances, due to the human respiratory defense mechanism, pathogens do not necessarily cause disease in the body, some factors can reduce their defense function, pathogens invade, and lead to disease. These incentives include:

Upper respiratory tract virus infection: Viral infection can destroy the integrity of the bronchial mucosa, affect mucus-cilia activity, and cause bacterial infection.

Sudden suffering, hunger, fatigue, drunkenness, etc., weaken the body's resistance, reduce cell phagocytosis, weaken immune function, and cause disease.

(3) Coma, anesthesia, and sedatives are overdose, which is prone to inhalation of foreign bodies and cause bacterial infection.

Suffering from some basic diseases, such as immunodeficiency, diabetes, renal failure, etc., are also susceptible factors.

Pathological changes of chronic pneumonia

Clinical manifestations of chronic pneumonia

Chronic pneumonia is characterized by periodic recurrence and deterioration, passing in a wave-like pattern. Symptoms vary depending on the stage, age, and individual of the lesion. The body temperature is normal during the resting period, no obvious signs, almost no cough, but easy to breathe when running and going upstairs. Pulmonary insufficiency is often associated with exacerbations, cyanosis and dyspnea, and external respiratory dysfunction due to reduced vital capacity and respiratory reserve and shortened breath hold time. After the deterioration, the recovery is very slow, sputum often occurs, and even facial swelling, cyanosis, chest deformation, and clubbing fingers and toes appear. Pulmonary emphysema and pulmonary insufficiency cause increased pulmonary circulation resistance, increased pulmonary artery pressure, and increased burden on the right heart. Pulmonary heart disease can occur within six months to two years. There may also be liver dysfunction. Increased white blood cells, moderately increased erythrocyte sedimentation. X-ray chest radiographs showed that the texture of the lungs in the lower field and hilar region of the two lungs could be honeycomb, with vesicular emphysema, and accompanied by substantial inflammatory lesions. The symmetry of the hilar shadows on both sides was increased. With the development of the disease, X-ray signs of pulmonary heart disease such as bronchiectasis, right ventricular hypertrophy, and pulmonary artery segment protrusion can also occur. In the presence of pulmonary heart disease, the electrocardiogram showed a clockwise inversion, the P wave was high and sharp, and most of the QRS comprehensive waves showed changes in the pattern of right ventricular hypertrophy.

Diagnosis of chronic pneumonia

History is extremely important in the diagnosis of this disease, often with recurrent sinusitis, bronchitis, or pneumonia, or with measles, whooping cough, influenza, or adenoviral pneumonia. Determining the diagnosis requires a combination of history, symptoms, and silk screening.

Differential diagnosis of chronic pneumonia

Special attention should be paid to identifying TB. The history of persistent lung infections after repeated upper and lower respiratory infections or infectious diseases, as well as the discharge of purulent sputum, are more common in chronic pneumonia. Tuberculin test and X-ray examination, hilar and paratracheal lymphadenopathy, can help diagnosis.

Causes of chronic pneumonia in the elderly

Immune function of the whole body and respiratory tract is reduced; the elderly suffer from diabetes and malignant tumors, and are prone to pneumonia; they are bedridden for a long time due to cerebrovascular accidents, trauma and aging, and prone to aspiration pneumonia and epidemic pneumonia; Many, such as bronchitis, chronic bronchitis, tuberculosis, and chronic heart failure are prone to respiratory infections; the number of elderly patients with gastroesophageal reflux increases, increasing the chance of suffering from aspiration pneumonia.

Prevalence of chronic pneumonia in the elderly

After the elderly suffer from pneumonia, the clinical manifestations are atypical, rapid changes, diversification, and poor prognosis. Due to the poor response ability of the elderly, fever may not be obvious, coughing is not heavy, sputum is not easy to cough, and chest pain is not significant. On the contrary, it can show symptoms of gastrointestinal tract, cardiovascular symptoms, systemic failure, and some frail people even have early shock, respiratory failure and multiple organ failure. The total number of white blood cells may not be high by laboratory tests, but the proportion of neutrophils is significantly higher. Because the basic functions of the organs of the elderly are poor, once combined with pneumonia, multiple organs can be involved, and the domino phenomenon appears, so that it becomes incurable.

Treatment of chronic pneumonia in the elderly

The first step is to use antibiotics properly and reasonably. Antibiotics can be selected based on the results of sputum culture and drug sensitivity experiments. Phlegm-free inhalation can be used to eliminate sputum in patients. Before bacteria are isolated, antibiotics can be used empirically. For socially acquired pneumonia, drugs against cocci and Haemophilus influenzae can be used first, such as penicillin, first-generation cephalosporins, and erythromycin; for patients with more severe conditions, second-generation cephalosporins can be used. Hospital-acquired pneumonia is mostly a conditional pathogen. Recently, Gram-negative bacteria have increased, such as Pseudomonas aeruginosa, cloacae, Klebsiella, Escherichia coli, and proteus. Drug-resistant Staphylococcus aureus and epidermis in cocci Staphylococci and enterococci are also not uncommon. Elderly pneumonia is often a mixed infection, and broad-spectrum and combined medication should be considered in treatment. The combination of drugs should consider the synergy between drugs to avoid antagonism and increase adverse reactions. Also consider the effects of antibiotics on the heart, liver, and kidneys. When many antibiotics are not sensitive, non-bacterial infections, such as fungi and viruses, should be considered.

Treatment of chronic pneumonia

The treatment of this disease requires long-term adherence to comprehensive measures. The main points of treatment are as follows:

Chronic pneumonia strengthens nutrition

Provide a nutritious and vitamin-rich diet. Actively treat malnutrition and rickets.

Chronic pneumonia exercise

Often do outdoor activities or sleep outdoors. Exercise such as gymnastics, cold water rubbing bath or cold water bath to enhance the body's cold resistance. Ventilation should be used in the room to keep the air fresh. Actively prevent respiratory infections.

Chinese medicine for chronic pneumonia

It is mainly to nourish the whole body and restore lung function.

Chronic pneumonia

If there is coexistence of sinusitis and bronchiectasis, appropriate treatment or surgical treatment should be taken.

Other treatments for chronic pneumonia

Appropriate antibiotics are nebulized, and antibiotics are used to control infections during repeated infections. Adrenocortical hormones can play a role in inhibiting proliferation and promoting lesion breathing. Tianjin Children's Hospital has treated 5 cases with prednisone for 2 to 12 months with good results. In addition, physical therapy such as electromagnetic therapy, ultra-shortwave diathermy, massage and mustard application can be used.

Chronic pneumonia prevention

The pathological recovery of acute pneumonia was later than the clinical recovery. Therefore, in the recovery period of severe pneumonia, physical therapy and gymnastics should be carried out to actively treat concurrent rickets and malnutrition, and follow-up and continue treatment after discharge until complete recovery. In addition, early childhood care should be taken to prevent measles, pertussis, influenza and adenovirus infections. Diffuse sinusitis and recurrent bronchitis should also be actively prevented. Patients with immunodeficiency can use immunostimulation therapy. Depending on the specific situation, they can be treated with human blood gamma globulin, transfer factor, thymosin or traditional Chinese medicine. If necessary, bone marrow transplantation can be used to rebuild immune function and prevent repeated infection and chronic pneumonia occur.