What Are the Different Types of Bronchiolitis Treatment?

The cause of bronchiolitis is mainly 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, the virus is small Capillary bronchial congestion, edema, increased mucus secretion, and necrotic mucosal epithelial cells fall off and block the lumen, resulting in significant emphysema and atelectasis. Inflammation often involves alveoli, alveolar walls, and interstitial lungs, so it can be considered a special type of pneumonia.

Ge Qiusheng

(Chief physician)

Pediatrics, Shenzhen Hospital

Bronchitis refers to the inflammation of the bronchi. The most common and serious child is bronchiolitis, which occurs in winter and can cause local epidemics. The lesions of bronchiolitis mainly occur in the bronchi of the lungs, that is, the bronchioles. Therefore, the disease is called "bronchiolitis", which is usually a complication caused by viral infections such as the common cold and influenza, and may also be caused by bacteria. The infection is a common type of acute lower respiratory tract infection in children.

Western Medicine Name: Bronchiolitis
Affiliated Department: Internal Medicine-Respiratory Medicine
Disease site: bronchus

The main symptoms: Cough, sneeze, fever, sputum
Main cause: Respiratory syncytial virus infection
Multiple groups: Children under 1 year
Contagious: Contagious

Causes of bronchiolitis

The cause of bronchiolitis is mainly 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, the virus is small Capillary bronchial hyperemia, edema, increased mucus secretion, and necrotic mucosal epithelial cells fall off and block the lumen, resulting in significant emphysema and atelectasis. Inflammation often involves alveoli, alveolar walls, and interstitial lungs, so it can be considered a special type of pneumonia.

Capillary bronchitis is different from general bronchitis or bronchitis. The clinical symptoms are like pneumonia, but mainly wheezing. This disease mostly occurs in children under 2.5 years old, 80% are under 1 year old, and most of them are under 6 months old. Children. ^[1] ^[2]

Capillary bronchitis epidemiology

Capillary bronchitis can sometimes cause epidemics. In the 1970s, the epidemic occurred three times in rural areas in southern China. In the 1980s, it was in the Yuncheng area of Shanxi. In the 1990s, it was epidemic in Beijing and Tianjin. There was still no understanding. At that time, the disease names were different and the pathogens were unknown. Later, the Ministry of Health organized a national collaboration to monitor and study the epidemic, and it was named "epidemic asthmatic pneumonia." Finally, in 1997, the pathogen of asthmatic pneumonia-respiratory syncytial virus was successfully isolated, and the epidemic pathogen was identified as respiratory syncytial virus A subtype. This will be useful for the future production of effective vaccines to prevent capillary bronchial Popularity has provided important evidence.

Clinical manifestations of bronchiolitis

Typical bronchiolitis usually occurs 2 to 3 days after an upper respiratory tract infection, with persistent dry cough and fever. The body temperature is characterized by moderate and low fever, and asthma is characteristic. The condition is 2 days after the occurrence of asthma. -3 days is more severe, breathing is significantly faster during the episode of wheezing, which can reach 60 to more than 80 times per minute, with prolonged exhalation and exhalation wheezing; severely ill children clearly show epistaxis and "three concavities" Symptoms "(ie, supraclavicular fossa, upper sternum fossa and upper abdomen depression during inhalation), pale face, blue mouth, or purpura, often irritable and moaning; children with more severe conditions may be combined with heart failure Or respiratory failure, which can be alleviated after treatment in most cases, with very few deaths.

Capillary bronchitis disease symptoms

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

(B) the disease can occur all year round, but more common in winter and spring.

(3) The onset is relatively rapid, and there are early symptoms of colds, such as cough and sneezing. The cough worsens after 1 to 2 days, and there is paroxysmal dyspnea, wheezing, pale, cyanosis of the lips, and three concave signs. Early wheezing of lung signs The sound is dominant, followed by wet sounds. Severe symptoms can be associated with congestive heart failure, respiratory failure, hypoxic encephalopathy, and water and electrolyte disorders. Generally, the body temperature does not exceed 38.5 ° C, and the course of disease is 1 to 2 weeks.

(4) The white blood cells are usually normal or slightly increased. Blood gas analysis showed that hypoxemia and arterial blood carbon dioxide partial pressure decreased or increased. Chest x-rays showed thickened lung texture, enhanced bilateral lung transparency, or small shadows and atelectasis. Conditions can be used for rapid diagnosis of respiratory secretion virus to determine the virus type.

Capillary bronchitis disease characteristics

Onset of bronchiolitis can be urgent and slow. Most of them first have symptoms of upper respiratory tract infections, and frequent and deep dry coughs may occur suddenly, and bronchial secretions gradually develop. Infants and young children do not expectorate and swallow more through the pharynx. Patients with mild symptoms had no apparent illness, and those with severe fever had a temperature of 38 to 39 ° C, occasionally reaching 40 ° C, and retreated within 2 to 3 days. Feeling tired, affecting sleep appetite, and even vomiting, diarrhea, abdominal pain and other gastrointestinal symptoms. Older children complained of headaches and chest pain. Cough usually lasts for 7 to 10 days, sometimes for 2 to 3 weeks, or recurrent. If not treated properly, it can cause pneumonia, white blood cells are normal or slightly lower, and those who are elevated may have secondary bacterial infections. Children with healthy bodies rarely have complications, but in children with malnutrition, low immune function, congenital respiratory malformations, chronic nasopharyngitis, and rickets, they are not only prone to bronchitis, but also complicated by pneumonia, otitis media, laryngitis, and parasinusitis. .

Complications of bronchiolitis

1. Bronchopneumonia: Children may develop complications such as high fever, hypoxia, dyspnea, acute respiratory failure, and even atelectasis, emphysema, empyema, pneumothorax, lung abscess, pericarditis, and sepsis, which can be life-threatening.

2. Bronchiectasis: When capillary bronchitis is not treated properly, it can be transformed into chronic bronchial purulent inflammation, which destroys the bronchial wall and deforms and expands the bronchial wall, and destroys the tube wall tissue, causing the bronchus to lose its original natural defense ability and reduces coughing efficiency. And sputum function, providing conditions for further infection. Over time, the vicious circle has further expanded, and the condition has worsened, making it difficult to cure. Children may have prolonged intermittent fever, with a large amount of purulent sputum or hemoptysis. Further development can lead to pulmonary heart disease.

3 Chronic bronchitis, emphysema, and pulmonary heart disease: If bronchiolitis cannot be completely cured and recurrent, it will turn into chronic bronchitis and further develop into emphysema and pulmonary heart disease. Children can have recurrent illness, long-term cough, expectoration, wheezing, labor shortness of breath, palpitation, cyanosis, edema, and long-term cure. ^[1] ^[3]

Diagnosis and identification of bronchiolitis

Diagnosis of bronchiolitis

I. Clinical manifestations

1. Fever, chills, headache, dry throat, etc.

2. The main symptoms are cough and sputum.

Second, the type of disease

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

2. Chronic bronchitis is dominated by a persistent cough, which does not heal for many months, and worsens sooner or later, especially at night. The amount of sputum is more or less, and coughing is faster. Symptoms are milder in summer and prone to acute attacks in winter, making the condition worse. Anti-relapse author, more thin and weak. May be complicated by atelectasis, emphysema, and bronchiectasis.

Third, auxiliary inspection

1. Early breath sounds can become thick, and blisters can be heard on both sides.

2. X-ray examination: no special findings were found in acute cases. Chronic patients may have corresponding chronic inflammation changes.

Differential diagnosis of bronchiolitis

(1) Those with less severe condition must be distinguished from upper respiratory tract infection.

(2) Bronchial foreign body: When there is airway obstruction and infection, its respiratory symptoms are similar to acute bronchitis. Pay attention to ask if there is a history of inhalation of foreign body in the airway. After treatment, the effect is not good. Chest X-ray examination showed obstruction such as atelectasis and emphysema.

(3) Hilar bronchial lymph node tuberculosis: According to the history of tuberculosis exposure, tuberculin test and chest X-ray examination.

(D) bronchiolitis: more common in infants under 6 months, with obvious acute episodes of wheezing and dyspnea. The body temperature is not high, and the rales in the lungs are not obvious at the onset of wheezing, and fine wet rales can be heard after remission.

(5) Bronchial pneumonia: When acute bronchitis is severe, it should be distinguished from bronchial pneumonia. ^[2] ^[4]

Capillary bronchitis disease treatment

Capillary bronchitis treatment principles

Children should be sent to the hospital for treatment after the onset of illness. Because bronchitis is mostly caused by a viral infection, antibiotic treatment is generally not required in the early stages of onset. If you are suspected of secondary bacterial infection in the late stage of the disease, you can use antibiotics. The symptomatic treatment is the main treatment. It can be summarized as "sedative cough". In addition, good care is also important. Pay special attention not to disturb the children and let them rest quietly. It is necessary to maintain a certain humidity and add enough low moisture. Children with severe illness can cooperate with inhalation and inhalation of sputum in time to keep the airway open. It can also be treated with Chinese medicine.

Capillary bronchitis treatment

(A) control infection

If acute bronchitis is a bacterial infection, the following antibacterial drugs can be used: Compound Xinnuomin 0.05 / kg / day for two oral administration, penicillin 3-50000 U / mg / day for two intramuscular injections, medicamycin, red 30-50 mg / kg / day of oral administration of 3-4 times. If there is no clear bacterial infection or mixed infection, or use ribavirin 10-15 mg / kg / day twice intramuscularly, or 5 mg / kg / day twice as nebulized inhalation, try a-interference. 200,000 U / day intramuscular injection.

(Two) symptomatic treatment

1. Antitussive and expectorant: if the sputum is sticky and difficult to suck out, you can use aerosolized inhalation and select 10% ammonium chloride mixture. ). . Frequent dry cough affects sleep and rest, can take a small amount of antitussive drugs, such as compound Folcodine syrup, 2-3 times a day, care should be taken to avoid overdose and prolonged time, affect the physiological vitality of cilia, make secretions difficult discharge.

2. Antispasmodic and asthma: Aerosolized inhalation therapy should be preferred. It can be combined with inhaled budesonide aerosolized solution 2ml, bromoisoprene solution 1ml, salbutamol solution 0.5ml, and normal saline 1ml inhaled for 5-7 days. If the effect is not good, aminophylline can be given: 2-4 mg / kg / time orally 3-4 times / day. Shuchuanling: 1-2 mg / day under 6 years old, orally 3-4 times or 0.1 mg / kg / times, and prednisone 1 mg / kg / day can be added in 3 times, 4-7 days is a course of treatment.

(Three) traditional Chinese medicine treatment

1. Antitussive and asthma: During the remission period, some traditional Chinese medicine preparations for antitussive and asthma can be used, which can also relieve symptoms to a certain extent.

2. External sticking medicine: After many infants and young children get sick, long-term medication can bring the poisonous effects of some drugs. The safety and convenience of external sticking Chinese medicine is also a good way. At present, there are a lot of herbs such as expectorant, phlegm-removing Baicaoqi paste and Sanjiu paste for winter.

(D) Massage therapy

Through traditional Chinese medical massage, acupoint massage and massage are performed on children with symptoms of bronchitis to unblock the breath to achieve a therapeutic effect.

Capillary bronchitis precautions

Children with bronchitis should pay attention to rest, maintain air circulation in the bedroom, and maintain proper temperature and humidity. Give digestible food and drink plenty of water. Provide complex vitamin B and vitamin C, 1 tablet each time, 3 times a day. For children with chronic and multiple onset, vitamin AD should be supplied, 1 tablet each time, 2-3 times a day. Juvenile and frail children can take sulfa drugs or penicillin drugs in mild cases, and be matched with certain phlegm and cough medicines to play a synergistic treatment. Sulfonamides can be used as a combination of sulfamethoxazole, 20 mg per kilogram of body weight per day, and taken orally twice a day. Due to the slow excretion of sulfa drugs, it is easy to cause crystal precipitation in the kidney, so sufficient water should be supplied during the medication to facilitate excretion. Some children are allergic to sulfa drugs. After use, rash, exfoliative dermatitis, etc., can not be used if you have a history of allergies. Penicillin drugs can be used amoxicillin, 40-80 mg per kilogram of body weight daily, orally after 3 to 4 meals. Oral penicillin drugs should also pay attention to whether there is a history of penicillin allergies, children with allergies to penicillin should be used with caution, specific children, and children who are prone to allergies should even be disabled. Such children can be changed to cephalosporins cefradine, 25-50 mg per kg of body weight daily, divided into 3 to 4 doses. Huatan antitussive medicine can be used Huatan tablets, 1/2 one l each time, 3 times a day.

For allergic cough caused by various reasons, an increase in eosinophil count can be found by blood examination. Such coughs often have a longer duration and can increase the antiallergic drug loratadine orally. For children who have repeatedly suffered from bronchiolitis, they should be allowed to actively participate in physical exercise, strengthen their physique, pay attention to changes in the climate, and avoid too much or too little clothing. If the bronchitis does not heal repeatedly, you should go to the hospital to check carefully for congenital malformations, bronchiectasis, hypoproteinemia, tuberculosis, and chronic sinusitis and tonsillitis. ^[1] ^[2] ^[3]

Prognosis of bronchiolitis disease

Most of the healing of bronchiolitis is good, and the course of disease usually ranges from 5 days to 9 days. However, it should be noted that children with capillary bronchitis are prone to asthma in the future. According to the national epidemiological survey of pediatric asthma and the follow-up of children with bronchiolitis in infants, it is found that 20% to 40% of them have Children develop asthma in children later, so we must actively prevent bronchiolitis to reduce the incidence of asthma.

Bronchitis Care

Bronchitis is a common respiratory disease in children with a high prevalence, which can occur throughout the year, and peaks in winter and spring. When suffering from bronchitis, children often have varying degrees of fever, cough, loss of appetite or vomiting, diarrhea, etc. Smaller children may also have wheezing, wheezing and other symptoms of bronchiolitis. Although a small number of children may develop bronchial pneumonia, most of the children are relatively mild. They are mainly treated and treated at home with medicines. Parents should follow the doctor's advice to give the children medicine and time home care:

I. Keep warm: temperature changes, especially cold stimuli, can reduce local resistance of the bronchial mucosa and aggravate bronchitis. Therefore, parents should add or remove clothing to children in time with temperature changes, especially to cover children during sleep. Good quilt

Keep your body temperature above 36.5 ° C.

Second, more water feeding : bronchiolitis has different degrees of fever, water evaporation is large, you should pay attention to feeding children with more water. It can be replenished with sugar water or sugar salt water, or with rice soup or egg soup. The diet is mainly semi-liquid to increase the body's moisture and meet the needs of the body.

Third, adequate nutrition: children with bronchiolitis suffer from a large consumption of nutrients, coupled with fever and bacterial toxins affecting gastrointestinal function, digestion and malabsorption, so the nutritional deficiency of children should not be ignored. In this regard, parents should take a small number of multiple meals method for children, giving a light, adequate nutrition, balanced and easy to digest and absorb semi-liquid or liquid diet, such as porridge, cooked noodles, egg custard, fresh vegetables, fruit juice and so on.

Fourth, turn over and pat back: When the child coughs and sputum, it shows that the bronchial secretions increase. To promote the smooth discharge of secretions, aerosolized inhalants can be used to help expectorants, 2 to 3 times a day, 5 to 20 minutes each. If it is an infant, in addition to patting the back, it should also help to turn over every 1 to 2 hours to keep the child in a semi-recumbent position to facilitate the discharge of sputum.

V. Antipyretic: Most patients with bronchiolitis have moderate to low fever. If the body temperature is below 38.5 , it is generally not necessary to give antipyretic drugs. The main purpose is to treat the etiology and fundamentally solve the problem. If the body temperature is high, older children can be physically cooled, that is, wet the head with a cold towel or wipe with warm water, but children should not use this method, if necessary, use drugs to cool down.

6. Maintain a good family environment: The child's room should be warm, well ventilated and well-lit, and there must be some humidity in the air to prevent excessive drying. If there is a smoker in the home, it is best to quit smoking or go outdoors to prevent the harmful effects of smoking on the child.

Prevention of bronchiolitis

First of all, pay attention to the child's hot and cold, do not wear too hot, and let him have appropriate cold tolerance exercise. The temperature is high, don't just think that the child is cold, but more importantly, pay attention not to keep the child warm at all times, so that the sweaty clothes are more likely to catch a cold. If your child has a cold, take some medication as soon as possible without delaying the illness.