chronic bronchitis in children
Introduction
Introduction to chronic bronchitis in children Chronic bronchitis refers to repeated bronchial infections with a course of more than 2 years. The attack time is more than 2 months per year. There are four major symptoms of cough, asthma, inflammation and phlegm. X-ray films show interstitial chronic bronchitis. , emphysema and other changes. Other diseases with such symptoms such as tuberculosis, lung abscess, heart disease, bronchiectasis, bronchial asthma, chronic nasopharyngeal disease, etc. should also be excluded. basic knowledge Sickness ratio: 28% Susceptible people: children Mode of infection: non-infectious Complications: atelectasis emphysema bronchiectasis
Cause
Causes of chronic bronchitis in children
(1) Causes of the disease
Simple chronic bronchitis is rare in children, generally associated with chronic sinusitis, proliferative inflammatory disease, primary or secondary respiratory cilia dysfunction, secondary to severe adenovirus pneumonia, measles pneumonia, bronchioles After inflammation and mycoplasma pneumoniae infection, it can also occur due to long-term inhalation of harmful dust and smoke, which weakens the respiratory defense function. Virus and bacteria can be the main pathogens of this disease.
(two) pathogenesis
Various causes cause cilia adhesion, lodging, devitalization, epithelial vacuolar degeneration, epithelial cell vacuolar degeneration, epithelial cell hyperplasia and squamous metaplasia; goblet cells and mucous gland hypertrophy and hyperplasia, strong secretion, resulting in a large amount of mucus retention, Mucosal and submucosal hyperemia, plasma cells, lymphocytic infiltration and mild fibrosis, as the disease continues to develop, inflammation spreads from the bronchial wall to its surrounding tissue, the submucosal smooth muscle bundle can rupture and atrophy, and the mucosa and perivascular fibrous tissue proliferate, resulting in The stenosis of the lumen can further develop into obstructive emphysema.
Prevention
Prevention of chronic bronchitis in children
Keep away from bad environment such as smoke and irritating gases, avoid contact with allergens, pay attention to climate change, reduce the number of attacks, increase outdoor activities and exercise to enhance physical fitness; strengthen personal hygiene, pay attention to nutrition, prevent colds; eliminate related causes, such as Sinusitis, proliferative inflammatory disease, etc.; follow-up and rehabilitation after severe pneumonia; do a good job of vaccination.
Complication
Complications of chronic bronchitis in children Complications atelectasis emphysema bronchiectasis
Bronchial or pulmonary interstitial destruction, can be complicated by atelectasis, emphysema, bronchiectasis. About half of the children are born and developed behind their peers and have poor physical strength. Children often feel chest pain. If you do not actively treat it, it will be frequent and aggravated, the disease will be delayed, the constitution will be weaker, and even in summer, it can also occur. It can also cause pneumonia, white blood cells are normal or slightly lower, and elevated people may have secondary bacterial infections. Physically healthy children have few complications, but in cases of malnutrition, low immune function, congenital airway malformation, chronic nasopharyngitis, rickets, etc., it is easy to find cases of bronchitis, pneumonia, otitis media, laryngitis and paranasal sinusitis.
Symptom
Chronic bronchitis symptoms in children Common symptoms Bronchial secretions increase bacterial infections Wheezing chest pain wheezing
About half of the children are born and developed behind their peers and have poor physical strength. It is more common in winter, and it gets worse in the morning and evening, especially at night. Often a persistent cough after a cold, unhealed for many days, or with mild to moderate wheezing, more or less sputum, comfortable after coughing. Children often feel chest pain. If you do not actively treat it, it will be frequent and aggravated, the disease will be delayed, the constitution will be weaker, and even in summer, it can also occur. Eventually due to bronchial or pulmonary interstitial destruction, pulmonary atelectasis, emphysema, and bronchiectasis may occur.
History
Slow onset, long course of disease, mostly in the winter, increased in the morning and evening, especially at night. Often have chronic rhinitis, sinusitis, adenoid hypertrophy and chronic tonsillitis and other diseases.
2. Clinical manifestations
(1) Symptoms: The main symptoms are cough, cough, or wheezing. Often a persistent cough after a cold, long-term unhealed, usually in the morning and night cough. The amount of cough can be more or less, generally white mucus or serous, foamy, even with bloodshot, accompanied by bacterial infection, mostly purulent sputum, more morning sputum. After getting up or changing position can stimulate drainage. Can be accompanied by varying degrees of wheezing, if accompanied by emphysema can be expressed as anxious after activity. About half of the children are born and developed behind their peers and have poor physical strength.
(2) Signs: In the acute attack period, the back or the bottom of the lungs can be smelled dry and wet, and can be reduced or disappeared after coughing. There may be wheezing and exhalation prolongation when there is emphysema.
Examine
Examination of chronic bronchitis in children
1. General examination: When the bacterial infection occurs, the total number of white blood cells and neutrophils may increase, and the asthmatic eosinophils may increase.
2. Etiology: sputum smear can be found in bacteria or a large number of damaged white blood cells and goblet cells, and sputum culture can find pathogenic bacteria.
3. X-ray examination: There may be no abnormalities in the early stage. Repeatedly, the author may have thickened lungs, disordered, mesh-like, strip-like or spotted shadows, which are obvious in both lower lung fields.
4. Respiratory function test: no abnormality in the early stage, when there is small airway obstruction, the maximum expiratory flow rate-capacity curve decreases significantly at 75% and 50% lung volume, and the disease progresses to obstructive ventilatory dysfunction, the first second The forced expiratory volume (FEV1) is reduced.
5. Others: Spiral CT examination and bronchial lipiodol angiography if necessary.
Diagnosis
Diagnosis and diagnosis of chronic bronchitis in children
diagnosis
1. The history of the disease is slow, the course of disease is long, and it is more common in winter. It is aggravated in the morning and evening, especially at night. It often has chronic rhinitis, sinusitis, adenoid hypertrophy and chronic tonsillitis.
2. Clinical manifestations
(1) Symptoms: The main symptoms are cough, cough, or wheezing. It often produces a persistent cough after a cold. It is not cured for a long time. It is usually based on morning and night cough, and the amount of cough can be more or less. Generally it is white mucus or serum, foamy, even with bloodshot, accompanied by bacterial infection, mostly purulent sputum, more sputum sputum in the morning, after getting up or position changes can stimulate drainage, may be accompanied by varying degrees of wheezing, If accompanied by emphysema, it can be expressed as shortness of breath after activity. About half of the children are born and developed behind the same age and have poor physical strength.
(2) Signs: In the acute attack period, the back or the bottom of the lungs can be smelled and dried. The wet voice can be reduced or disappeared after coughing. When there is emphysema, there may be wheezing and exhalation.
Differential diagnosis
Combined with medical history, clinical manifestations and X-ray examination, it can be confirmed for diagnosis, but should be associated with chronic sinusitis, proliferative hypertrophy, sleep apnea syndrome, tuberculosis, variant asthma, bronchiectasis, cilia dysfunction and gastroesophageal Identification of chronic respiratory diseases such as reflux.
1. Bronchial asthma: characterized by repeated cough and asthma, sudden sudden stop, two lungs full of wheezing during the attack, asymptomatic after remission, often family or personal allergy history, cough as the main symptom of bronchial asthma cases There is no wheezing or wheezing sound, but it must be differentiated from this disease.
2. Tuberculosis: fever, fatigue, night sweats and weight loss, sputum found tubercle bacilli and chest X-ray examination can help identify.
3. Bronchiectasis: manifested as recurrent cough, cough, hemoptysis, a large number of purulent sputum when combined with infection, common lung texture of X-ray chest radiograph is rough or curly, spiral CT examination and bronchial lipiodol angiography can help diagnose .
