Pediatric Chronic Pneumonia

　　1. Causes of Disease

　　Recurrent aspiration pneumonia caused by various reasons, such as gastroesophageal reflux of gastric contents, may lead to persistent pneumonia if secondary infection or foreign bodies cannot be removed for a long time; chronic sinusitis and early pulmonary cystic fibrosis can cause recurrent pneumonia, which is difficult to control completely; pulmonary cystic fibrosis complicated with infection, congenital pulmonary malformation complicated with infection, and ciliary fixation syndrome can cause refractory pneumonia; immune deficiency patients with pneumonia and chronic interstitial pneumonia have certain difficulties in treatment. The factors that promote chronic pneumonia include the following:

　　1. Nutritional Diseases

　　Various nutritional diseases such as malnutrition, iron deficiency anemia, rickets due to vitamin D deficiency, etc., often lead to lung infections due to reduced immune function and are often difficult to treat. Deficiency of vitamins (such as vitamin A) and trace elements (zinc, iron) can easily lead to pneumonia and recurrent attacks, which are difficult to control. Congenital heart disease or tuberculosis patients who develop pneumonia are prone to prolonged disease course.

　　2. Viral Infection

　　Interstitial pneumonia is prone to evolve into chronic pneumonia.

　　3. Causes

　　Recurrent upper respiratory infections or bronchitis, as well as chronic sinusitis, are all causes of chronic pneumonia.

　　4. Respiratory Foreign Bodies

　　Foreign bodies deep in the bronchi, especially those without irritability and not producing initial acute fever (such as date pits), may be overlooked and remain in the lungs for a long time, forming chronic pneumonia.

　　5. Immune Deficiency

　　Including defects in humoral and cellular immunity, complement deficiency, and defective phagocytic function of leukocytes, all of which can lead to recurrent pneumonia and eventually become chronic.

　　6. Ciliary Dysfunction

　　Abnormal morphology and function of respiratory cilia in primary or secondary respiratory diseases can lead to chronic lung inflammation.

　　Second, Pathogenesis

　　Inflammatory lesions can involve all levels of bronchi, alveoli, interstitial tissues, and blood vessels. Especially in the inflammation of interstitial tissues, there is progression with each attack, leading to the destruction of elastic fibers in the bronchial wall, and ultimately resulting in stenosis due to fibrosis. At the same time, due to the obstruction of secretions, atelectasis of the lung occurs, leading to bronchiectasis. Due to the destruction of the bronchial wall and alveolar walls, air spreads through the lymphatic vessels into the tissue spaces, forming interstitial emphysema. Local blood vessels and lymphatic vessels also develop proliferative inflammation, with thickened walls and narrowed lumens.

　　Emphysema, pulmonary dysfunction, pulmonary heart disease, liver dysfunction, and anemia, etc.

　　The essence of liver dysfunction is the变性 and necrosis of liver cells, which inevitably leads to the escape of enzymes from liver cells into the blood. The synthesis of proteins, glycogen, and the processing of bilirubin, ammonia, and other substances that require liver processing are reduced in the liver cells. Therefore, routine enzyme, protein, and bilirubin tests are important for clinical diagnosis.

　　The characteristics of chronic pneumonia are periodic recurrence and deterioration, showing a wave-like course. Due to the different stages of the disease, age, and individual differences, the symptoms are various. In the stationary phase, the body temperature is normal, there are no obvious signs, almost no cough, but it is easy to breathe heavily when running or climbing stairs. In the deterioration phase, it is often accompanied by pulmonary dysfunction, cyanosis, and dyspnea. Due to the decrease in lung volume and respiratory reserve and the shortening of apnea time, excessive ventilation of the external respiration function occurs. The improvement after deterioration is very slow, and it is often coughed up phlegm. Even facial edema, cyanosis, chest deformity, and clubbing of fingers and toes may occur. Due to emphysema, pulmonary dysfunction, and increased pulmonary circulation resistance, the right heart burden is increased, and pulmonary heart disease may occur within half a year to two years. There may also be liver dysfunction, increased white blood cells, and moderate acceleration of ESR.

　　The recovery of the pathological condition of acute pneumonia is later than the clinical recovery. Therefore, during the recovery period of severe pneumonia, physical therapy and gymnastics should be carried out, and complications such as rickets and malnutrition should be actively treated. Follow-up and continued treatment should be carried out after discharge until complete recovery. In addition, efforts should be made to prevent measles, pertussis, influenza, and adenovirus infection during the infancy period. For children with immune deficiency, immunomodulatory therapy can be adopted, and human blood gamma globulin, transfer factor, thymosin, or traditional Chinese medicine can be selected for treatment according to specific conditions. Bone marrow transplantation can be used if necessary to reconstruct immune function and prevent recurrent infections and chronic pneumonia.

　　1. Blood count

　　Increased white blood cells, increased neutrophils, and anemia.

　　2. Blood biochemistry

　　Erythrocyte sedimentation rate (ESR) acceleration, liver function damage, vitamin and element deficiency, and low immune function.

　　3. Pathogen examination

　　Various methods can be used to find the pathogen, such as throat swab culture, sputum culture, bronchoalveolar lavage, lung puncture culture, virus isolation, immunological examination, and PCR technology.

　　4. X-ray

　　The chest X-ray shows that the lung texture in the middle and lower fields of both lungs and the hilum area can be honeycomb-like, with small bubble-like emphysema. At the same time, it can also be accompanied by实质性 inflammatory lesions. The shadows of both hilum areas can be symmetrically enlarged. With the development of the disease, bronchiectasis, right ventricular hypertrophy, and prominence of the pulmonary artery segment can also occur, which are X-ray signs of pulmonary heart disease.

　　5. Electrocardiogram

　　When there is pulmonary heart disease, the electrocardiogram shows counterclockwise rotation, a high and pointed P wave, and the majority of QRS complexes show changes such as right ventricular hypertrophy.

　　1. Fluids, especially fruit juices; apple juice, peach juice, watermelon juice, etc. can be eaten.

　　2. Fresh fruits and vegetables; celery, cabbage, rapeseed, radish, potato, sweet potato, soybean, etc.

　　3. Fatty fish, eggs, and other foods rich in vitamin A.

　　4. Avoid sticky, greasy, and difficult-to-digest foods; avoid high-fat and fried, grilled, and roasted foods.

　　5. Regular outdoor activities or outdoor sleep; exercises such as calisthenics, cold water sponge baths, or cold water baths to enhance the body's cold resistance; indoor ventilation and air exchange should be maintained to keep the air fresh; actively prevent respiratory tract infections.

　　I. Treatment

　　Comprehensive measures need to be taken for a long time in the treatment of this disease.

　　1. Strengthen nutrition

　　Chronic pneumonia often complicates with chronic diseases such as malnutrition, rickets, anemia, and low immune function. At this time, comprehensive treatment should be carried out, otherwise pneumonia is prone to recurrence. Provide a diet rich in nutrition and vitamins. Actively treat malnutrition and rickets, etc.

　　2. Physical exercise

　　Regular outdoor activities or outdoor sleep; exercises such as calisthenics, cold water sponge baths, or cold water baths to enhance the body's cold resistance; indoor ventilation and air exchange should be maintained to keep the air fresh; actively prevent respiratory tract infections.

　　3. Traditional Chinese medicine treatment

　　It is mainly to benefit the whole body and restore lung function.

　　4. Eliminate the focus of infection

　　If there are coexisting conditions such as sinusitis and bronchial dilation, appropriate treatment or surgical treatment should be adopted.

　　5. Other treatments

　　Irrigation with appropriate antibiotics, and the use of antibiotics to control infection in case of repeated infections. Adrenal cortical hormones can play a role in inhibiting proliferation and promoting the absorption of lesions. Tianjin Children's Hospital once used prednisone (prednisone) to treat 5 cases, with a medication duration of 2 to 12 months, and good effects. Non-specific immunomodulatory drugs can be considered for repeated infections to enhance immune function. In addition, physical therapies such as electromagnetic therapy, short-wave diathermy, massage, and mustard poultice can also be used.

　　II. Prognosis

　　If chronic pneumonia cannot be cured completely, it often leads to malnutrition, weakened constitution, and even more serious conditions such as emphysema and cardiopulmonary disease due to lung origin, which may threaten life.