Chronic bronchitis in children

　　1. Etiology

　　Simple chronic bronchitis is rare in children and is generally associated with chronic sinusitis, adenoiditis, primary or secondary abnormal respiratory cilia function. It may occur secondary to severe adenovirus pneumonia, measles pneumonia, capillary bronchitis, and mycoplasma pneumonia infection, or due to long-term inhalation of harmful dust and smoke, which weakens the respiratory tract defense function. Viruses and bacteria can be the main pathogens of this disease.

　　2. Pathogenesis

　　Various causes cause the cilia of airway epithelial cells to adhere, invert, and fall off, with vacuolation, necrosis, hyperplasia, and squamous metaplasia of epithelial cells; goblet cells and mucous glands become hypertrophic and hyperplastic, with abundant secretion, causing a large amount of mucus retention, congestion of the mucosa and submucosa, infiltration of plasma cells and lymphocytes, and mild fibrous hyperplasia. If the condition continues to develop, inflammation may spread from the bronchial wall to the surrounding tissues, causing the smooth muscle bundles in the submucosa to break and atrophy, fibrous hyperplasia around the mucosa and blood vessels, leading to lumen stenosis, and further developing into obstructive emphysema.

　　The destruction of bronchi or interstitial lung tissue can lead to complications such as atelectasis, emphysema, and bronchiectasis. About half of the children have growth and development lagging behind their peers, and are physically weaker. The children often feel chest pain. If not treated actively, it may occur frequently and worsen, with a prolonged course, weaker physique, and even onset in summer. It can also cause pneumonia, with normal or slightly low white blood cells, and those with elevated levels may have secondary bacterial infection. Complications are rare in healthy children, but they are easily found in children with malnutrition, low immune function, congenital respiratory tract malformations, chronic nasopharyngitis, rickets, etc., where cases of bronchitis, pneumonia, otitis media, laryngitis, and paranasal sinusitis are common.

　　1. Medical history

　　The onset is slow and the course is long, mostly occurring in winter, with morning and evening exacerbations, especially at night. Chronic rhinitis, sinusitis, adenoid hypertrophy, and chronic tonsillitis are often present at the same time.

　　2. Clinical manifestations

　　1. Symptoms

　　The main symptoms are cough and sputum, or accompanied by wheezing. Persistent coughing after a cold is common, which may not heal for a long time, mainly coughing in the morning and at night. The amount of sputum can be more or less, generally white mucous or serous, foamy, and occasionally with blood streaks. When there is bacterial infection, it is mostly purulent sputum, and more sputum is excreted in the morning. Changing positions may stimulate sputum production. It may be accompanied by varying degrees of wheezing, and if accompanied by emphysema, it may manifest as dyspnea after exercise. About half of the children have growth and development lagging behind their peers, and are physically weaker.

　　2. Signs

　　During the acute attack phase, dry and wet sounds can be heard in the back or at the bottom of both lungs, which may decrease or disappear after coughing. Wheezing sounds and prolonged expiration may occur when emphysema is present.

　　It is advisable to keep away from bad environments such as smoke and dust, irritant gases, and avoid contact with allergens, pay attention to changes in weather conditions to reduce the frequency of attacks, increase outdoor activities and exercise to enhance physical fitness; strengthen personal hygiene, pay attention to nutrition, and prevent colds; eliminate related causes of disease, such as sinusitis, adenoiditis, etc.; pay attention to follow-up and rehabilitation after severe pneumonia; and do a good job of vaccination prevention.

　　1. General examination

　　In the case of bacterial infection, an increase in the total white blood cell count and neutrophils, as well as an increase in eosinophils in asthma type, may occur.

　　2. Pathogen examination

　　The sputum smear may show bacteria or a large number of destroyed white blood cells and goblet cells, and sputum culture may detect pathogenic bacteria.

　　3. X-ray examination

　　In the early stage, there may be no abnormalities. In recurrent cases, the lung markings may become coarser and disordered, showing reticular, striated, or spotted shadows, which are more prominent in the lower lung fields.

　　4. Respiratory function examination

　　In the early stage, there may be no abnormalities. When there is a small airway obstruction, the maximum expiratory flow-volume curve shows a significant decrease in flow at 75% and 50% of the lung volume. When the condition progresses to obstructive ventilatory dysfunction, the first second forced expiratory volume (FEV1) decreases.

　　5. Other

　　If necessary, perform spiral CT examination and bronchial iodine oil contrast examination.

　　1. Foods should be light

　　Fresh vegetables such as cabbage, spinach, rapeseed, radish, carrot, tomato, cucumber, and winter melon can not only supplement various vitamins and inorganic salts but also have functions of clearing phlegm, extinguishing fire, and promoting defecation; soybeans and soy products contain high-quality protein needed by the human body, which can supplement the nutritional loss caused by chronic bronchitis without the disadvantages of phlegm and fire formation.

　　2. Strengthening daily diet

　　If a child's cough persists for a long time, it will consume the vital energy, weaken the lung and spleen. Therefore, it is advisable to choose foods with properties of invigorating the spleen, benefiting the lung, reinforcing the kidney, regulating qi, and resolving phlegm, such as the lungs of pigs, cows, and sheep, loquat, tangerine, pear, lily, jujube, lotus seed, almond, walnut, and honey, which can help enhance physical fitness and improve symptoms.

　　3. Avoid seafood and greasy foods

　　Since 'raw fish generates fire, and meat generates phlegm,' children with chronic bronchitis should eat less yellow croaker, herring, shrimp, crab, and fatty meat to prevent the generation of fire and phlegm.

　　4. Avoid刺激性食物

　　Spicy foods such as chili, pepper, garlic, scallion, and chives can all stimulate the respiratory tract, exacerbating symptoms; it is also not advisable to add too much salt or sugar to dishes, and the temperature should be moderate.

　　5. Chewing dried ginger can alleviate chronic symptoms

　　According to traditional Chinese medicine, dried ginger is a key medicine for treating cold syndrome with phlegm and cough. Dried ginger has a warm nature and a spicy taste, with the effects of dispelling coldness, warming the middle-jiao, removing phlegm, and stopping vomiting. It has a good therapeutic effect on chronic tracheitis with cold symptoms. Moreover, before going to bed, holding a piece of dried ginger in the mouth can alleviate coughing at night. According to modern pharmacological analysis, dried ginger mainly contains gingerol, borneol, gingerol, citric acid, and other components, which have the effects of dispelling wind and coldness and chasing away pathogenic factors. It is a folk custom to prevent common cold with wind and cold by drinking ginger-sugar water after being caught in the rain or wading through water. Dried ginger also has the effect of exciting the sympathetic nerve of the vascular motor center, which can enhance the ciliary movement of the tracheal mucosal cells, facilitating the upward movement and excretion of phlegm.

　　1. Treatment

　　1. General Measures

　　It must be noted that nutrition is important, and outdoor activities and physical exercise should be strengthened. For related causes such as sinusitis, adenoiditis, and others, timely radical treatment should be given. After severe pneumonia, it is necessary to follow up and observe for a relatively long time, especially for children with adenovirus pneumonia, X-ray reexamination should be done until recovery. It is important to pay attention to seasonal changes and avoid possible allergens to reduce the frequency of attacks. Non-specific triple vaccine injection can improve serum interferon and white blood cell phagocytic ability, which is worth trying.

　　2. Traditional Chinese Medicine Therapy

　　Traditional Chinese medicine calls this disease 'Internal Injury Cough', which is often caused by chronic cough affecting the internal organs and their function. According to clinical manifestations, it is divided into phlegm cough and lung dryness cough. The treatment method focuses on invigorating the spleen and drying dampness, resolving phlegm and relieving cough, and benefiting yin and moistening the lung, and can be combined with辨证施治 based on clinical manifestations.

　　(1) Phlegm cough: mainly characterized by copious phlegm, white and thin phlegm that is easy to cough up, chest and epigastric stuffiness, loss of appetite, normal tongue color, white greasy coating, slippery or slippery pulse. Treatment is to invigorate the spleen and dry dampness, resolve phlegm and relieve cough. commonly used Erchen Decoction with modifications. Example prescription: Fuling 9g, Juhong 9g, Banxia 6g, Xingren 6g, Sūzi 6g, Baijiezi 1.5g. Can be modified: ① If there is loose stools and white greasy coating, add Stir-fried Yiyiren 9g, Dangshen 9g, remove Xingren and Sūzi. ② When there is a phlegm sound, add Xixin 1.5g, Shengjiang 3g.

　　(2) Dry cough due to lung dryness: persistent cough, dry cough with little phlegm, yin deficiency with fever, thirst, dry throat, or emaciation with night sweats, feverishness of the palms and soles, slightly red tongue with little coating or thin coating, thready and rapid pulse. Treatment is to nourish yin and moisten the lung to relieve cough. commonly used Shaoshen Maidong Decoction with modifications. Example prescription: Shaoshen 9g, Maidong 9g, Baiqian 9g, Bai bu 9g, Zǐ yùn 9g, Xingren 6g, Qingdài 3g, Wumei 9g.

　　2. Prognosis

　　If chronic tracheobronchitis in children cannot be effectively controlled, it often affects normal growth and development, leads to decreased physical fitness, or causes complications that affect the prognosis. Chronic bronchitis in children is not caused by a single factor and may be related to various factors such as low immunity, bronchial foreign bodies, and congenital abnormalities in bronchial and pulmonary development. Through chest X-ray examination in children, even bronchoscopy, once the chronic bronchitis in children and its causes are clarified, it is necessary to actively remove the causes, combine with anti-infection and symptomatic treatment measures, and most children can be cured with a good prognosis.