Acute tracheobronchitis in children

　　1. Etiology

　　Mainly due to infection. The pathogens are viruses, mycoplasma pneumoniae, or bacteria, or a combination of infections. Among viral infections, influenza, adenovirus, type 3 parainfluenza virus, and respiratory syncytial virus are the most common. Mycoplasma pneumoniae is also not uncommon. Any virus that can cause upper respiratory tract infection can become a pathogen for bronchitis. On the basis of viral infection, pathogenic bacteria can cause secondary infection. Common bacteria include pneumococcus, group A beta-hemolytic streptococcus, staphylococcus, and Haemophilus influenzae. Sometimes, Bordetella pertussis, Salmonella, or Corynebacterium diphtheriae may be involved. Environmental pollution, air pollution, or frequent contact with toxic gases can also stimulate the bronchial mucosa and trigger inflammation. Low immune function or specific quality, such as malnutrition, rickets, allergic reactions, and chronic rhinitis, pharyngitis, etc., can be predisposing factors for the disease.

　　2. Pathogenesis

　　The airway lumen of children is narrow, the cartilage is soft, lacks elasticity, the mucosa is soft, delicate, and rich in blood vessels, and the mucous glands secrete insufficiently and are relatively dry, etc., which are anatomical and physiological characteristics and poor immune function, making respiratory tract infections easy to occur in children. When tracheitis and bronchitis occur, mucosal congestion is an early change, followed by desquamation, edema, infiltration of submucosal leukocytes, the production of thick or mucopurulent secretions, dysfunction of bronchial cilia, macrophages, and lymphatic defenses, allowing bacteria to invade the normally sterile bronchi, followed by the accumulation of cell fragments and mucopurulent secretions. Coughing is necessary for the elimination of bronchial secretions. The edema of the bronchial wall, retention of secretions, and bronchospasm in some patients can lead to airway obstruction.

　　Complications are rare in healthy children, but in children with malnutrition, low immune function, congenital respiratory tract malformations, chronic nasopharyngitis, rickets, and other diseases, complications such as pneumonia, otitis media, laryngitis, sinusitis, and others are more likely to occur. If the child has signs of prolonged expiration and tracheal retraction, indicating respiratory distress, it may be asthma bronchitis, which is more common in children with allergic constitution. If the child has significant cyanosis, it indicates that the condition is worsening, and if not treated in time, it is easy to develop into pneumonia.

　　The onset of the disease is mostly preceded by symptoms of upper respiratory tract infection, which can also suddenly appear frequent and deep dry coughs, followed by gradual sputum production in the bronchi, with dry and moist rales heard in the chest, mainly with non-fixed moderate vesicular sounds, occasionally limited to one side. Infants and young children cannot cough up phlegm and often swallow it through the throat. Mild symptoms may not have obvious illness, while severe cases may have a fever of 38-39°C, occasionally up to 40°C, lasting for 2-3 days, feeling fatigue, affecting sleep and appetite, and even vomiting, diarrhea, abdominal pain, and other gastrointestinal symptoms. Older children may complain of headache and chest pain. Cough usually lasts for 7-10 days, sometimes lasting for 2-3 weeks, or recurring. Without appropriate treatment, it can cause pneumonia. Generally, the white blood cell count is normal or slightly low, and an increase may indicate secondary bacterial infection.

　　1. Positive exercise

　　It is very important to use natural factors to exercise the physique, such as frequently opening windows for sleep, outdoor activities, and physical exercise, which are positive methods. As long as they are persistent, they can enhance the physique and prevent upper respiratory tract infections.

　　2. Maintain hygiene

　　Avoiding causes of onset such as wearing too many or too few clothes, excessive or low room temperature, sudden changes in weather, environmental pollution, and passive smoking are all causes of upper respiratory tract infections.

　　3. Avoid cross-infection

　　Wash hands after contacting patients. In general kindergartens and hospitals, it is necessary to wear isolation clothes when necessary, which not only protects adjacent children but also can reduce the occurrence of complications in patients. The ward should implement ventilation and air exchange, maintain appropriate temperature and humidity, and disinfect the patient's bedding and clothing in a timely manner to prevent the spread of pathogens. At home, adult patients should avoid contact with healthy children.

　　4. Drug Prevention

　　Kasuan, infants and young children 5ml, children 10ml oral, 3 times/d, 3-6 months as a course of treatment. Levamisole 2.5mg/(kg·d), taken for 2 days a week, 3 months as a course of treatment. Astragalus 6-9g per day, taken continuously for 2-3 months. These drugs have the effect of improving the body's cellular and humoral immune function. After application in children with recurrent upper respiratory tract infections, the frequency of recurrence can be reduced. Beijing Friendship Hospital Department of Pediatrics has used the traditional Chinese medicine modified Yubing Feng San (formula: raw Astragalus 9g, Baizhu 6g, Fangfeng 3g, raw Oyster Shell 9g, Chenpi 6g, Shanyao 9g, ground into fine powder) twice a day, 3g each time, taken orally. After 3 years of observation, it is believed that this medicine may improve the immunity of weak children and reduce the incidence of recurrent respiratory tract infections.

　　5. Vaccination

　　It is recently believed that the use of attenuated virus vaccines, administered intranasally and/or nebulized inhalation, can stimulate the production of secretory IgA on the surface of the nasal and upper respiratory tract mucosa, thereby enhancing the respiratory tract's defense against infection. A large number of studies have pointed out that secretory IgA has a better effect against respiratory tract infections than any serum antibody. Due to the large number of serotypes of enteroviruses and rhinoviruses, it is difficult to prevent them with vaccines.

　　1. Blood count

　　Blood leukocytes are normal or slightly low, and in secondary bacterial infections, the total number of leukocytes and the proportion of neutrophils can increase. In children with wheezing bronchitis, the proportion of eosinophils in blood leukocyte classification increases.

　　2. Serum antibodies

　　The serum IgE level in children with wheezing bronchitis is elevated, X-ray examination is normal or there is increased pulmonary texture in both lungs, and children with asthmatic bronchitis may show mild emphysema in both lungs.

　　1. Drink more vegetable and fruit juices

　　It can not only relieve cough and phlegm, but also supplement vitamins and minerals, which is very beneficial for the recovery from the disease.

　　2. Eat more green vegetables

　　For each meal, eat a moderate amount of vegetables and dairy products, such as radish, carrot, and green leafy vegetables, which are light and easy to digest.

　　3. Eat more asthma-relieving foods

　　Eat more cough-suppressing, asthma-relieving, expectorant, warming the lung, and spleen-invigorating foods, such as white fungus, loquat, pomelo, pumpkin, yam, chestnut, lily, kelp, and seaweed, etc.

　　First, Treatment

　　1. General Treatment

　　For adjustments to rest, diet, indoor temperature and humidity, see "Upper Respiratory Tract Infection". Infants should often change positions to make respiratory secretions easier to expel. When frequent coughing interferes with rest, expectorant drugs can be given. It should be avoided to give antitussive drugs such as tolevamine, promethazine, or those containing opium, codeine, and other ingredients to prevent inhibiting the excretion of secretions. When acute bronchitis occurs with spasm, bronchodilator drugs can be given. The following traditional Chinese medicine treatment methods can also be adopted. Mild cases can be treated according to "real heat asthma", and severe cases can refer to the treatment methods for capillary bronchitis and bronchial asthma.

　　2. Traditional Chinese Medicine Treatment

　　This disease is known as exterior cough in traditional Chinese medicine. Due to different pathogenic factors, it is clinically divided into wind-cold cough, wind-heat cough, and real heat asthma. The treatment method is to disperse wind and cold, clear heat and promote lung function, and lower fever and relieve asthma. It can be combined with clinical辨证施治.

　　(1) Wind-cold cough: Characterized by sudden onset of cough with a sharp, frequent voice, thin phlegm, nasal congestion, clear nasal discharge, itching throat or headache, aversion to cold or no fever, slight white fur on the tongue, floating pulse. Treatment is to use acrid and warm herbs to relieve the exterior and stop coughing. commonly used modified杏苏散. Prescription example:杏仁6g, 苏叶3g, 前胡9g, 半夏6g, 牛蒡子6g, 生姜3 slices.

　　(2) Wind-heat cough: Cough is not comfortable, and phlegm is mainly yellow and sticky. There is redness and dryness of the throat, nasal congestion with yellow snot, or accompanied by fever and sweating, thin yellow tongue coating, floating rapid pulse. Treatment is to use acrid-cooling to relieve the exterior, ventilate the lung, and stop coughing. Frequent use of Sangju Decoction with modifications. Prescription example: Sangye 9g, Juhua 9g, Xingren 6g, Baiqian 9g, Pipaye 9g, Jiegeng 6g, Huangqin 6g. The above two types can add 1-2 other herbs according to the condition: ① When fever is severe, add Qingdai 3g, Shengshi 15g. ② When coughing is severe, add BaiBu 9g. ③ When phlegm is abundant, add Susu 6g, Laiwanzi 9g.

　　(3) Exuberant heat asthma: In addition to the above symptoms, the child has a high fever and is accompanied by shortness of breath. Treatment is to ventilate the lung and resolve phlegm, and calm the asthma. Frequent use of Mahuang Xinggan Decoction with modifications. Prescription example: Mahuang 3g, Xingren 6g, Shengshi 15g, Gancao 3g, Qingdai 3g, Susu 6g, Laiwanzi 9g, and 1-2 additional herbs can be added according to the condition: ① When the exterior pathogen is severe, add Juhua 9g, Xianlugen 15g. ② When heat is severe, add Huangqin 6g, Yinhua 9g, and Lianqiao 9g. ③ When coughing is severe, add Qianhu 9g or BaiBu 9g. ④ When asthma is severe, add Yujin 6g, Ganyin 9g, or Shengzhishi 1.5g. ⑤ When phlegm is abundant, add Tianlizi 9g, and Woyao 9g. 3. Other treatments can use a moderate amount of ipecac syrup, 2-15 drops per dose for infants and young children, 1-2 ml per dose for older children, 4-6 times a day, which can make phlegm easier to cough up. 10% ammonium chloride solution also has the same effect, with a dose of 0.1-0.2 ml/kg per dose. Bromhexine can dilute phlegm and enhance the ciliary movement function of the bronchial mucosa. For children under 1 year old, 2-4 mg per dose, for children aged 1-4 years, 8 mg per dose, and for older children, 12 mg per dose. Taken orally, 3 times a day. When bacterial infection occurs, appropriate antibiotics can be selected. In addition, for persistent bronchitis, ultrashort wave or ultraviolet irradiation can be added.

　　II. Prognosis

　　With good care and appropriate treatment, the prognosis is generally good. With the removal of the cause, the tracheobronchial tissue can completely return to normal. The prognosis is good. However, if effective treatment is not received, the condition often becomes chronic or may worsen and develop into pneumonia.