Words are not consecutive when speaking
Introduction
Introduction In children with acute asthma attack, the child is irritated, sitting and breathing, shrugging and breathing, more excitable difficulty, pale, nose flapping, lips and nails bruising, cold sweating, assisting respiratory muscle contraction, private chest tightness, Shortness of breath, even when speaking, words cannot be continuous. The incidence of asthma in the world is between 0.1% and 32%, and the difference is close to 300 times. The reason may be related to genetics, age, geographical location, climate, environment, ethnicity, industrialization, urbanization, interior decoration, living standards, diet. Habits and so on.
Cause
Cause
(1) Causes of the disease
The incidence of asthma in the world is between 0.1% and 32%, and the difference is close to 300 times. The reason may be related to genetics, age, geographical location, climate, environment, ethnicity, industrialization, urbanization, interior decoration, living standards, diet. Habits and so on.
The factors that induce bronchial asthma are multifaceted. Common factors include the following:
1, allergens: Allergens are roughly divided into three categories: 1 pathogens causing infection and their toxins. Children with asthma attacks are often closely related to respiratory infections. More than 95% of infant asthma is caused by respiratory infections. The main pathogens are respiratory viruses such as syncytial virus (RSV), adenovirus, influenza, and parainfluenza virus. Syncytial virus infection has been shown to cause wheezing due to the occurrence of specific IgE-mediated type I allergies. Other local infections such as sinusitis, tonsillitis, dental caries, etc. may also be predisposing factors. 2 inhalation: usually inhaled from the respiratory tract, domestic application skin test shows that the main allergens causing asthma are dust mites, house dust, mold, multi-valent pollen (Artemisia, ragweed), feathers, etc., also reported to contact silkworm hair Asthma, especially as an inhalation allergen, plays an important role in allergic diseases of the respiratory tract. In childhood, allergies to ticks are more than adults. Spring and autumn are the shortest suitable season for cockroaches, so dust mites Asthma occurs in spring and autumn, and is common in nighttime cases. In addition, asthma attacks caused by inhalation of allergens are often related to the season, region and living environment. Once the contact is stopped, the symptoms can be alleviated or disappeared. 3 food: mainly heterosexual proteins, such as milk, eggs, fish and shrimp, spices, etc., food allergies are common in infancy, gradually decreasing after 4 to 5 years old.
2, non-specific stimulating substances: such as dust, smoke (including cigarettes and mosquito coils), odor (industrial irritating gas, cooking oil smell and oily knee taste). These substances are non-antigenic substances that stimulate the senile nerve endings and vagus nerves of the bronchial mucosa, causing reflex cough and bronchospasm. Long-term persistence can lead to high airway responsiveness, and sometimes inhalation of cold air can also induce bronchospasm. Some scholars believe that air pollution is becoming more and more serious, and it may be one of the important reasons for the increased prevalence of bronchial asthma.
3. Climate: Children's patients are very sensitive to climate change. For example, if the temperature suddenly becomes cold or the pressure drops, it can often trigger asthma attacks. Therefore, the incidence of children in spring and autumn is generally increased.
4, mental factors: children with asthma, mental factors caused by asthma attacks are not as obvious as adults, but asthma children are often affected by emotions, such as crying or anger and fear can cause asthma attacks. Some scholars have proved that ecstasy is often accompanied by emotional excitement or other mental activity disorders.
5, genetic factors: asthma is hereditary, children with family and personal allergies, such as asthma, infant eczema, urticaria, allergic rhinitis, etc., the prevalence is higher than the general population.
6, sports: foreign reports about 90% of children with asthma, exercise can often stimulate asthma, also known as exercise induced asthma (EIA), more common in older children, violently sustained (5-10 minutes or more) after running the most It is easy to induce asthma, and its mechanism is 100-immunity.
7, drugs: drugs caused by asthma is also more common. There are two main types of drugs, one is aspirin and similar antipyretic analgesics, which can cause so-called endogenous asthma, such as accompanied by sinusitis and nasal polyps, called aspirin triad. Other similar drugs are indomethacin, mefenamic acid and the like. The mechanism that causes asthma may be that aspirin inhibits prostaglandin synthesis, leads to a decrease in cAMP content, and releases chemical mediators to cause asthma. Such asthma often decreases with age and has less incidence after puberty. Another type of drug is a drug that acts on the heart. For example, propranolol and equal heart can block the receptor and cause asthma. In addition, many spray inhalants can also cause bronchospasm caused by irritation of the throat, such as sodium cromoglycate, Net, etc. Others such as lipiodol angiography, sulfa drug allergy can often induce asthma attacks.
(two) pathogenesis
Bronchial asthma is a complex disease caused by a variety of factors. The pathogenesis is still unknown, and the currently recognized mechanisms have the following three aspects.
1. Type I allergic reaction and IgE synthesis regulation disorder: After the antigen (allergen) first enters the human body, it acts on B lymphocytes, making it a plasma cell to produce IgE, and IgE is adsorbed on mast cells or basophils. The Fc segment binds to a specific receptor on the surface of the cell membrane, so that IgE is firmly adsorbed on the cell membrane, causing the body to be sensitized. When the corresponding antigen re-enters the sensitized body, it binds to IgE on mast cells and basophils, causing degranulation of the cell membrane, releasing a series of chemical mediators including histamine, slow-reacting substances, bradykinin, serotonin and Prostaglandins, etc., these biologically active substances can cause vasodilatation, enhanced permeability, smooth muscle spasm and glandular hypersecretion and other biological effects, causing bronchial asthma.
In recent years, many studies have shown that the increase of IgE is also related to cellular immune dysfunction. A large number of studies have proved that T cells not only have quantitative changes, but also may have functional defects. In addition, high IgE may also be associated with delayed T cell maturation.
2, airway inflammation changes: through the fiberoptic bronchoscopy and bronchoalveolar lavage (BAL) biopsy of asthma animal models and asthma patients, demonstrating that airway tissue shows varying degrees of inflammatory changes.
3, airway hyperresponsiveness: airway hyperresponsiveness, that is, the airway has abnormally increased reactivity to various specific or non-specific stimuli. Airway hyperresponsiveness is present in children with asthma. Airway hyperresponsive immediate response (type I allergy), and sustained response. It is currently believed that sustained airway hyperresponsiveness is mainly associated with airway inflammation. The mechanism of high airway response during inflammation is mainly related to inflammatory mediators. Studies have found that the reactivity of the airway to histamine and acetylcholine is parallel to the severity of the disease in children with sling. These are in turn associated with neuromodulation disorders, particularly autonomic dysfunction.
It is known that bronchial smooth muscle is dominated by sympathetic and parasympathetic nerves and maintains a dynamic balance under the regulation of the brain-lower hypothalamus-pituitary. Normal human bronchial smooth muscle tone depends on the excitatory state of cholinergic receptors, while asthmatic children do not, their parasympathetic tone is increased, alpha adrenergic nerve activity is enhanced, and adrenergic nerve function is low or partially blocked. Because of these abnormalities, airway responsiveness in children with asthma is one of the pathophysiological basis of asthma attacks.
The main pathological changes of asthma are bronchial smooth muscle spasm, inflammatory cell infiltration, upper basement membrane thickening and airway mucosal edema, epithelial shedding mixed cell debris, increased mucus secretion, mucociliary dysfunction, and then bronchial mucosal hypertrophy and endobronchial Mucus embolism. As a result of the above pathological changes, the airway lumen is narrowed, resulting in increased airway resistance and asthma.
Examine
an examination
Related inspection
Electrocardiogram blood routine
Clinical manifestations: In acute attacks, the child is irritated, sitting and breathing, shrugging and breathing, more excitable difficulty, pale, nose flapping, lips and nails bruising, cold sweating, assisting respiratory muscle contraction, private chest tightness Short, even when speaking, words cannot be continuous. After proper treatment, if the white sticky sputum can be discharged after coughing, the symptoms can be slightly relieved. Infants and young children mainly rely on abdominal breathing. Because their thorax is soft, they often do not have sitting breathing. However, parents often hold their heads and stick their heads on the shoulders of their parents. They are emotionally disturbed and irritable. Three infestation occurred during inhalation, that is, the upper sternal fossa, the supraclavicular fossa, and the lower part of the rib arch showed a depression, while in the exhalation, the intrathoracic pressure increased, and the upper and lower sternum were convex. Jugular vein engorgement can be seen in older children. Auscultation can have wheezing or dry and wet rales, sometimes breathing sounds can be covered by it, such as severe airway obstruction, respiratory sounds can be significantly reduced. The heart rate is often accelerated. When emphysema occurs, the liver and spleen can be touched under the ribs. In severe cases, heart failure can be complicated.
1, eosinophils: Most children with allergic rhinitis and asthma blood eosinophil count more than 300 × 106L (300 / mm3). Eosinophilia and Colesmann's spirochete and Charcot's crystal can also be found in sputum.
2, blood routine: red blood cells, hemoglobin, total white blood cells and neutrophils are generally normal, but the total number of white blood cells can be increased after the use of beta receptor agonists. If a bacterial infection is combined, both increase.
3, chest X-ray examination: most of the remission period is normal, most of the sick children in the attack period can be simply over-inflated or accompanied by increased hilar vascular shadow; in the case of co-infection, pulmonary infiltration can occur, and other complications can occur There are different images, but the chest X-ray helps to rule out asthma caused by other causes.
4, skin allergen examination: The purpose of examining allergens is to understand the pathogenesis of asthmatic children and choose specific desensitization therapy. The skin test is an inducing test performed on the skin with an allergen, usually on the extension side of the upper arm. There are three main methods: 1 patch test: used to determine the sensitizer of exogenous contact dermatitis; 2 scratch test: mainly used to detect the sensitizer of the rapid response, drop a test solution at the test site, and then Scratches were performed, and the depth of the scratches was not bleeding. The reaction was observed after 20 minutes, and the positive reaction was characterized by redness and wheal. The advantage of this method is safe and does not cause violent reaction, but the disadvantage is not as sensitive as intradermal test; 3 intradermal test: high sensitivity, easy operation, no special equipment, is the most common method for specificity test. Generally used to observe the rapid reaction, but also to observe the delayed reaction. The amount of the allergen infusion to be injected by the intradermal test is 0.01 to 0.02 ml. Generally, the concentration of the immersion liquid is 1:100 (W/V), but the pollen is used in a concentration of 1:1000 to 1:10000.
The purpose of the skin test is to clarify the allergens that cause asthma. Therefore, sympathomimetic, antihistamines, theophylline, and corticosteroids should be discontinued 24 to 48 hours before the skin test to avoid interference.
5, pulmonary function test: Pulmonary function test is important to estimate the severity of asthma and judge the efficacy. It generally includes lung volume, lung ventilation, diffusion function, flow rate-capacity map, and respiratory mechanics test, but all require more sophisticated instruments and cannot be monitored at any time. Children with asthma often show an increase in total lung volume (TLC) and functional residual capacity (FRC), while residual gas (RV) and vital capacity (VC) can be normal or decreased; the more important change is the change in respiratory flow rate. Forced vital capacity (FVC), a less forced expiratory flow rate (FEF25-75%), and maximum expiratory flow rate (PF).
Diagnosis
Differential diagnosis
Dust mites allergic asthma can also cause words to be contiguous when speaking. However, the most common cause of asthma in children should be distinguished.
