Pediatric bronchial asthma

　　Pediatric bronchial asthma is an atopic disease related to genetic inheritance, and environmental factors also play an important role in the onset. The specific causes of onset are as follows.

　　1. Respiratory infection

　　1. Respiratory virus infection:During the infantile period, there are mainly respiratory syncytial virus (RSV), parainfluenza virus, influenza virus, and adenovirus. Other viruses such as measles virus, mumps virus, enterovirus, and poliomyelitis virus are occasionally seen.

　　2. Mycoplasma infection:Due to the immature immune system of infants and young children, mycoplasma can cause chronic respiratory tract infections in infants and young children. If not treated properly, it can lead to recurrent, non-healing cough and wheezing.

　　3. Respiratory focal infections:Chronic sinusitis, rhinitis, otitis media, and chronic tonsillitis are common focal chronic upper respiratory tract lesions in children.

　　II. Inhalation of allergens

　　Respiratory allergies in children over 1 year of age gradually form. If the child is allergic to indoor allergens such as dust mites, cockroaches, pet fur, and outdoor pollen, and if they inhale low concentration allergens for a long time, it can induce chronic airway allergic inflammation, cause sensitization of the body, and produce chronic atopic airway inflammation. As the time of contact with allergens increases, the airway inflammation gradually worsens, often developing into pediatric asthma.

　　III. Gastroesophageal reflux

　　Gastroesophageal reflux is one of the important causes of persistent wheezing. Clinically, it often manifests as severe coughing and wheezing upon falling asleep, and the child may have symptoms of regurgitation or vomiting during the day.

　　IV. Genetic factors

　　Many survey data show that the prevalence of asthma in relatives of asthma patients is higher than in the general population, and the closer the kinship, the higher the prevalence. At present, the related genes of asthma have not been fully identified. However, studies have shown that there are multiple gene loci associated with allergic diseases. These genes play an important role in the pathogenesis of asthma.

　　V. Other factors

　　Inhalation of irritant gases or intense exercise, crying, shouting, paint, coal smoke, and cold air can all act as non-specific irritants to trigger asthma attacks.

　　Pediatric bronchial asthma often leads to complications such as emphysema, pulmonary heart disease, respiratory failure, pneumothorax, mediastinal emphysema, shock, locked-in syndrome, and growth and development delay, so it should be highly regarded by clinical doctors and parents of children with asthma.

　　The symptoms of pediatric bronchial asthma are mainly divided into the following types:

　　1. Symptoms during attacks

　　The child may be restless, have difficulty breathing, with more pronounced expiratory difficulty, often unable to lie flat. When sitting, they may hunch their shoulders and bend their back, showing a typical sitting breathing difficulty. The child's face may turn pale, the nostrils may flutter, the lips and nails may become cyanotic, and they may even sweat coldly and look frightened and restless.

　　2. Symptoms during intercritical periods

　　At this time, although there is no difficulty in breathing, the child's appearance is like a normal child, but they may still feel discomfort in the chest. Since the pathological factors causing bronchial sensitivity still exist, asthma attacks can be triggered immediately upon infection or contact with allergens from the outside.

　　3. Chronic recurrent symptoms

　　Asthma itself is a chronic disease, and some children have attacks throughout the year, or even if the disease can be controlled with medication, the remission period is very short. Physical examination may show a barrel-shaped chest, increased anteroposterior diameter, downward displacement of the diaphragm, and reduced relative cardiac dullness.

　　When preventing pediatric bronchial asthma, the following points should be noted:

　　1. Try to avoid triggers and pay attention to keeping warm. Avoiding pollen can reduce the impact of the spring flowering season on allergic asthma.

　　2. Keep the room temperature comfortable and the air fresh. Avoid inhaling dust, smoke, gas, and other substances. Children with asthma are very sensitive to temperature changes, and sudden cold weather or decreased atmospheric pressure can often trigger asthma attacks.

　　4. Reduce the mental stimulation of the child, eliminate the mental burden, and encourage the child to build confidence in fighting the disease.

　　3. Pay attention to strengthening physical exercise in daily life, often go outdoors, enhance physical fitness, and improve the ability to resist diseases.

　　In diagnosing pediatric asthma, in addition to relying on clinical manifestations, chemical tests are also required. The main inspection methods include the following:

　　1. Blood routine examination

　　During an attack, there may be an increase in eosinophils, but most are not obvious. If related to viral infection, the white blood cell count is usually normal or reduced. If concurrent infection occurs, the white blood cell count may increase.

　　2. Sputum examination

　　Under the microscope, smears show a large number of eosinophils, and there are sharp棱 crystals formed by the degeneration of eosinophils. If there is a respiratory tract bacterial infection, Gram staining of sputum smears, cell culture, and drug sensitivity tests can help in the diagnosis of pathogenic bacteria and guide treatment.

　　3. Blood gas analysis

　　During severe asthma attacks, there may be hypoxia, with a decrease in PaO2 and SaO2. Due to overventilation, PaCO2 may decrease and pH may increase.

　　4. Chest X-ray examination

　　During asthma attacks in the early stage, there may be increased lung transparency and an overinflated state. During the remission period, there are usually no obvious abnormalities.

　　Pediatric asthma patients should eat more foods rich in magnesium and calcium, and more vitamin-rich foods. Drink plenty of water to dilute sputum and make it easier to cough up. Children should avoid eating刺激性 foods and cold or hot foods during their daily life.

　　During an acute attack of pediatric asthma, various measures are taken to relieve bronchospasm, improve pulmonary ventilation function, and control infection. The treatment of acute attacks mainly includes oxygen therapy, bronchodilators, and corticosteroids. The types and dosages of drugs used depend on the severity of the asthma attack. The main asthma drugs include two major categories, namely sympathomimetic amines and cholinergic antagonists. Sympathomimetic amines vary depending on their action on cell receptors. Common sympathomimetic amines include drugs that excite α receptors and β1 receptors. Theophylline drugs are the most commonly used bronchodilators. Anticholinergic drugs mainly include ipratropium bromide and scopolamine.