2 English reference laennec &; Calling language (abbreviation for apostrophe)
Streptococcus mucositis
3 disease alias asthmatic bronchitis, asthmatic bronchitis
4 disease code ICD:J20.8
5 classification of pediatric diseases
6 disease overview Asthmatic bronchitis is just a clinical concept, which refers to a group of infants with asthma-like lower respiratory tract infection, which is a clinical syndrome. The onset age is relatively young, and it is more common in children aged 1 ~ 3 years. Often secondary to upper respiratory tract infection, the condition is mostly mild, with low or moderate fever, and only a few sick children have high fever.
7 disease description Asthmatic bronchitis is just a clinical concept, which refers to a group of infants with lower respiratory tract infection accompanied by asthma. It is a clinical syndrome, and generally refers to a group of infants with acute bronchial infection accompanied by wheezing. Pulmonary parenchyma is rarely involved, and some children can develop bronchial asthma. Because the baby's trachea and bronchus are relatively narrow, it is easy to aggravate the condition due to infection or other * * *. In addition, children have allergic physical factors, which cause bronchospasm or swelling and wheezing after upper respiratory tract infection. Therefore, some people think that some children with this disease are children with bronchial asthma (hereinafter referred to as asthma) or mild asthma.
8 Symptoms and signs are shown as follows:
1. The onset age is relatively young, and it is more common in children aged 1 ~ 3 years.
2. The general manifestations are often secondary to upper respiratory tract infection, most of which are not serious, showing low or moderate fever, and only a few sick children have high fever. Exhale time is prolonged, accompanied by wheezing and rough rales, and wheezing has no obvious attack. The above symptoms were obviously relieved on the 5th to 7th day after treatment.
3. Prognosis The recurrence of some cases is mostly related to infection. Most of them have good short-term prognosis, and the number of recurrences decreases when they are 3 ~ 4 years old. However, some cases develop bronchial asthma for a long time.
4. Diagnostic criteria (scoring method) 1988 The National Children's Asthma Conference put forward the diagnostic criteria (scoring method) for evaluating infant asthma: the principle of scoring authors with repeated wheezing under 3 years old:
(1) If an infant suffers from bronchiolitis or asthmatic bronchitis and has repeated wheezing attacks ≥3 times, score 3 points.
(2) wheezing in the lungs is 2 points.
(3) The symptom of sudden wheezing is 1.
(4) The child has other allergic history (1).
(5) First-and second-degree relatives have a history of eczema, dermatitis or asthma, and the score is 1.
The total score above is more than 5 points, and it is diagnosed as infantile asthma, with only two wheezing attacks or a total score less than 4 points. It is newly diagnosed as asthmatic bronchitis, and follow-up observation is continued.
The causes of diseases can include the following factors:
1. Infection factors can cause various viral and bacterial infections. The more common are syncytial virus, adenovirus, rhinovirus and mycoplasma pneumoniae. Most cases can be complicated with bacterial infection on the basis of virus infection.
2. Anatomical features The trachea and bronchi of infants are relatively narrow, and the elastic fibers around them are not well developed, so their mucous membranes are susceptible to infection or other * * * swelling and congestion, resulting in narrow pipes and sticky secretions that are not easy to discharge, resulting in wheezing.
3. There are many infants infected by viruses with allergic constitution factors, and only a few children show asthmatic bronchitis, suggesting that different pathophysiological changes and clinical manifestations of the same virus in different individuals are closely related to internal factors of the body. For example, in recent years, it has been found that children with asthmatic bronchitis caused by syncytial virus have specific IgE antibodies, and the histamine concentration in nasopharyngeal secretions is significantly higher than that of children with the same infection but no wheezing. Their relatives often have a history of allergic diseases such as allergic rhinitis, urticaria and asthma. About 30% children have suffered from eczema, and the serum IgE content is often increased.
10 pathophysiology The pathogenesis of asthmatic bronchitis is similar to asthma. The pathogenesis of asthma has been studied in recent years, which can be roughly divided into the following three aspects.
1. Allergy is the main cause of some asthmatic bronchitis and bronchial asthma. Allergy refers to the reactive changes of the body when it comes into contact with external antigens, which is a special type of immune response. It can be divided into four types, namely immediate allergic reaction type, cytolysis type, immune complex type and delayed type. Patients with allergic asthma mainly have type ⅰ and type ⅱ abnormal reactions.
2. The role of adrenergic receptors Some people think that all the causes of asthma are through the same way, that is, the responsiveness of the respiratory tract of asthma patients to various causes increases, which can cause smooth muscle spasm at a low threshold. The respiratory tract is controlled by autonomic nerve, which makes smooth muscle contract when vagus nerve is excited and relax when sympathetic nerve is excited. Sympathetic nerves are rarely distributed directly in bronchi, but in cholinergic ganglia, which can eliminate bronchial contraction caused by vagus nerve impulse through transmission, mainly through catecholamine and abundant β receptors in circulation.
3. Genetic factors As early as 1650, Senus reported that his wife's family had asthma patients for three consecutive generations. William found that 50% of the close relatives of asthma patients have a history of allergic diseases. The survey results of Pediatric Hospital affiliated to Shanghai Medical University show that the incidence of asthma in relatives of children with asthma at all levels is significantly higher than that in the control group, and there is an increasing trend with the approach of parents, that is, the closer the parents are, the higher the incidence of asthma, indicating that asthma is closely related to heredity.
1 1 diagnosis: most of them are children under 3 years old, and most of them occur after upper and lower respiratory tract infections. Respiratory syncytial virus, parainfluenza virus and influenza virus are common pathogens. It has the characteristics of fever, prolonged expiratory time, wheezing, rough and wet rales, etc. After treatment for about 1 week, the symptoms are obviously relieved and it is easy to diagnose.
Laboratory examination: white blood cell count can be increased and virus infection can be normal. Other routine tests are normal. Eosinophil examination and serum IgE level may increase in some children.
Other auxiliary examinations: There is no obvious abnormality in chest X-ray examination, but there may be bronchitis changes.
Table 1 summarizes the similarities and differences of 12 in the differential diagnosis of wheezing-like diseases of lower respiratory tract in infants, which can be used as a reference for differential diagnosis.
For children with asthmatic bronchitis, we should pay attention to the analysis of family and children's own allergic history, eosinophil examination, serum IgE level and other data. If bronchial asthma is suspicious, preventive measures should be taken as soon as possible.
13 The treatment plan is acute bronchitis.
1. The general treatment is according to the routine treatment of respiratory tract infection, including rest, proper indoor temperature and humidity, frequent dressing change, plenty of boiling water and digestible diet. Pay attention to respiratory isolation to reduce the chance of secondary bacterial infection.
2. Virus is the main pathogen to control infection. Although bacteria exist in secretion culture, they are not real pathogens, so broad-spectrum antibiotics are generally not used. Antibiotics, such as sulfamethoxazole/trimethoprim (compound sulfamethoxazole) or penicillin intramuscular injection, can be appropriately used for infants with fever and significantly increased white blood cells. If the condition is serious, young and weak, penicillin, kanamycin (or gentamicin) and other broad-spectrum antibiotics can be combined.
3. Symptomatic treatment includes:
(1) relieving cough and resolving phlegm: Objective To make the sputum thinner and easier to discharge. Generally, antitussive drugs or sedatives are not used as much as possible, because they not only inhibit cough reflex and affect the physiological activities of cilia, but also make it difficult to discharge sputum, cause bronchial obstruction and increase the chance of bacterial infection.
Commonly used expectorants are Tugen syrup 0. 1 ~ 1m 1, 3 times/d; L0% ammonium chloride 0. 1 ~ 0.2m 1/kg, 3 times/d; Bromhexine (Bissouping) 2 ~ 4 mg, 3 times a day. If the dry cough is serious and affects sleep, a small dose of sedative can be given.
(2) Asthma relief: In asthmatic bronchitis, wheezing is often difficult to control. In addition to bronchial antispasmodics, such as aminophylline 2 ~ 4 mg/kg, taken orally, or inhaled with isoproterenol 0.5mg and 4% sodium bicarbonate 2m 1 by atomization. At the same time, pay attention to hydrating and diluting sputum. When wheezing is severe, prednisone (1mg/kg/ day) can be taken orally for three times, with 4-7 days as a course of treatment. As for antiallergic drugs, such as promethazine (phenazine), it can remove phlegm and should be used as little as possible.
Complications of 14 generally have no complications. It can develop into pneumonia, and some children will develop into asthma later.
15 prognosis and preventive prognosis: most cases have a good short-term prognosis, and the number of recurrences decreases at the age of 3-4, but some cases develop into bronchial asthma for a long time.
Prevention: If children with asthmatic bronchitis are suspected of bronchial asthma, preventive measures should be given as soon as possible. Methods to prevent recurrent or chronic bronchitis:
1. General methods First find the cause, actively treat chronic diseases or prevent potential factors, so as to reduce the chance of acute attack. Secondly, give reasonable feeding, add complementary food in time to enhance physical fitness. And strengthen physical exercise, do more outdoor activities, and take vitamin A orally when necessary to increase the resistance of respiratory mucosa.
2. Bronchitis vaccine can produce immune response, increase phagocytic function and prevent the recurrence of bronchitis. Usage: During the intermission, subcutaneous injection 1 time per week, the first time 1 time 0. 1m 1. If there is no adverse reaction, increase it by 0. 1ml every week until 0.5m 1 is the maximum dose. 10 is 1 course of treatment, and effective patients can use several courses of treatment, especially in frequent seasons, and the remission period is suspended.
3. Nuclear cheese is the hydrolysis product of nucleic acid and casein, which can enhance the body's resistance. Usage: intramuscular injection twice a week, 2m 1 and 10 times each time is a course of treatment, and it can be continued to be used when effective.
16 Epidemiology Some cases developed into bronchial asthma for a long time. From 1987 to 1989, 594 cases of asthmatic bronchitis were followed up for 4 ~ 2 1 year. Results 4 1% turned to asthma, of which 6 1.8% was cured and 38.2% still had asthma attacks. People with allergic history, high eosinophils and elevated serum IgE often have bronchial asthma. According to the follow-up observation of 146 cases of asthmatic bronchitis in Tianjin Medical College, it is considered that asthmatic bronchitis and bronchial asthma are the same disease because their genetic history, allergic history, serum IgE and lung function are very similar. The pediatrics department of Xi 'an Medical University also thinks that unexplained repeated wheezing in children under 3 years old should be considered as infantile asthma, which may be a different manifestation of a disease in two age stages from childhood asthma.
17 suggests actively treating chronic diseases or preventing potential factors to reduce the chance of acute attack. Secondly, give reasonable feeding, add complementary food in time to enhance physical fitness. And strengthen physical exercise, do more outdoor activities, and take vitamin A orally when necessary to increase the resistance of respiratory mucosa. Bronchitis vaccine can produce immune response, increase the function of phagocytes and prevent the recurrence of bronchitis.
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