Children’s respiratory respiratory disease -related diseases are a group of respiratory syndrome characterized by “asthma”. The incidence of breathing is very high, and the 1/3 infants will experience an asthma before the age of 3, half of which will last until 5 to 6 years old.
So why do children breathe so much? Will children’s asthma disease develop into asthma? How to avoid the development of asthma diseases into asthma? How should children’s asthma disease be treated? In order to figure out these issues, we are fortunate to invite Professor Yin Yong in Shanghai Children’s Medical Center. He will combine the latest “glucocortic hormone atomization inhalation therapy in February 2018 (2018 revised version) “(Hereinafter referred to as” consensus “) detailed answers to the above questions, and shared wonderful views. Hurry up and see it!
1 Why are there so many children’s breathing?
Children’s breathing is very common in pediatric clinics. Professor Yin Yong summarized with three numbers. “About 1/3 of children had at least once in the age of 3; 50%of the children who are breathing have experienced a panting attack. “
The reason why children are prone to breathing, “this is related to the children’s own anatomy, physiology and immune factors,” Professor Yin Yong pointed out. Children’s airway is relatively narrow, the mucosa is tender, the blood vessels are rich, and the local barrier function is also incomplete. Therefore, children’s airway is a “good” medium for bacteria and viruses. It is not difficult to understand that children are prone to respiratory tract infections and breathing. It is precisely because of the above three aspects that children’s asthma disease is a type of disease that pediatrics attach great importance to.
The most common chronic diseases of pediatric respiratory systems are asthma, but asthma does not mean asthma, and there are many reasons for asthma. Therefore, it is necessary to identify in different asthma. Classification of phenotypes for preschool children’s breathing:
So, can we identify well based on the phenotype of the panting?
In 2014, the British Asthma Management Guide (BTS/SIGN) pointed out that asthma phenotype usually comes from retrospective analysis. When the child appears for the first time, the phenotype classification can not be able to distinguish the patients, and the phenotype will grow up with them. And changes. Therefore, many scholars believe that asthma phenomenon is of less significant guidance in clinical treatment.
Because of this, it is very difficult to distinguish different types of breathing with phenotypes. Experts hope that through the “Consensus”, children’s asthma disease is explained in depth to regulate our clinical diagnosis and treatment. Children’s asthma -related diseases include bronchial asthma, asthma bronchitis, capillary bronchitis, asthma pneumonia and others. The consensus of this expert mentioned a new term called asthma pneumonia, similar to asthma pneumonia, all refers to pneumonia with asthma.
2 Circular supporting bronchitis
■ Overview of capillary bronchitis
Circular bronchitis is a common disease in children. It refers to infant diseases that mainly take asthma as the main symptoms. They mainly occur in infants and young children under 2 years old. Month-March of the following year), accumulated a capillary trimmed by 75um ~ 300um.
《毛细支气管炎诊断、治疗和预防专家共识》（简称，2014年版毛细支气管炎共识）对毛细支气管炎的定义强调临床症状，包括3点：1.年龄<2岁；2.前驱症状：病毒性Symptoms related to upper respiratory tract infections; 3. Clinical manifestations: multiple symptoms and signs, but focus on exhaustion and breathing.
Professor Yin Yong pointed out that “respiratory tract hypotenosis (RSV) is a pathogenic factor that causes children’s hair bronchitis.” A number of accommodation analysis shows that in the pathogenesis of childbirth bronchitis pathogenic virus, the respiratory tract sync virus accounts for 60%-80%.
Children’s hair bronchitis is the immune mechanism caused by virus infections, and inflammation is an important factor in the onset of hair bronchitis in children. A variety of inflammatory cells and factor participating in the onset of hair bronchitis have led to an increased edema/damage to the tract wall, increased mucus production, etc. The inflammation affects the surroundings of the bronchial pipe, and the airway epithelium is damaged, causing the airway part or completely blocking.
Professor Yin Yong pointed out that “In the pathogenic mechanism of bronchitis, bronchial smooth muscle contraction in the disease causes less pathogenic effects, which is why the bronchitis relaxation agent is not good for bronchitis.” Professor Yin Yong believes that “the key point of such diseases is to reduce inflammation, and inhalation of glucocorticoids (ICS) can effectively alleviate the inflammatory cell infiltration of capillary bronchitis and reduce airway inflammation. For severe cases, even intravenous veins need to be intravenous. Use glucocorticoids to relieve inflammation. “
■ Will capillary bronchitis develop into asthma?
The capillary bronchitis began to show the symptoms of the upper drive of upper respiratory tract infection. After a few days, it gradually advanced to the lower respiratory tract infection, and even respiratory suspension may even occur. Respiratory suspension is often found in severe cases with high risk factors. These high -risk factors include premature birth, contemporary heart, Tang’s syndrome, abnormal neuromuscular development, early onset (<3 months), etc. (<3 months) and so on.
In the past, capitis may be the first attack of asthma. Research on genetics shows that capitis and asthma have a common genetic gene. So, does capillary bronchitis think it is the first attack of asthma? Does these genes cause future asthma risks for children with capitis? For children with specific constitutions, the symptoms of rhinoplasty infection may be more prominent, and multiple infections may develop into asthma. Professor Yin Yong said, “RSV may be the starting factor of asthma. If the child has a characteristic constitution and the rhinoplasty is infected in the future, it may develop into persistent asthma or asthma.” Some research shows that capillary bronchitis is accompanied by specialty. Sexual physical children developed as high as 65%of asthma; there are also reports that 42%~ 90%of asthma disease will evolve into asthma.
■ Treatment of capillary bronchitis
In 2014, the consensus of capillary bronchitis pointed out the treatment principles of capillary bronchitis: treatment principles are supporting and maintaining internal environmental stability, improving ventilation, anti -gas inflammation reactions, prevention and treatment of complications and complications. Therefore, while using β2ra (SABA) and antibroxine drugs (SAMA) to relieve spasm and relaxing bronchies, atomization inhale inhaled Buddine mixed suspension to eliminate non -specific airway inflammation, improve ventilation, restore lung function is important. Treatment measures.
Professor Yin Yong concluded, “For the treatment of capillary bronchitis, the most important thing is to control the inflammation of the airway, reduce the high reactivity of the airway and expand the bronchial pipe.”
Professor Yin Yong also reviewed the literature and pointed out that atomization inhalation into Putidal can reduce the symptoms of asthma, reduce repeated asthma, reduce the risk of oral hormones and the risk of progress as asthma. In the end, Professor Yin Yong summarized “The incidence of capillary bronchitis is high, and about 1/3 children have at least once gaspy before 3 years old, which is seriously harmful. Circable bronchitis has asthma risk. The risk of up to 65%; atomization inhalation of Bu Di Need is a preferred treatment of capillary bronchitis, which can improve the symptoms, reduce the risk of oral hormones, and reduce the risk of future asthma. “
3 Asthma bronchitis and asthma pneumonia
Asthma bronchitis refers to an acute bronchial-bronchitis accompanied by asthma and has pathological changes similar to capillary bronchitis. It mainly affects the trachea, bronchial, and fine pilot (the difference from capillary bronchitis). Clinically, cough, asthma, shortness of breath, and dual lung lung sounds are the main manifestations, which can often occur repeatedly.
Symptoms of asthma 3 times and above can be called repeated asthma. Studies have shown that the pathological changes of asthma characteristics have occurred in preschool asthma: Compared with the control group, the thickness of the base membrane is significantly thickened, and eosinophilic particle cell inflammation is also significantly enhanced. Professor Yin Yong pointed out, “Among children with asthma in school age, characteristic pathological changes in adults and school -age children have occurred, prompting treatment intervention at this stage to change progress into asthma.”
The treatment of asthma bronchitis mainly includes three aspects: acute seizures, maintenance treatment, and pre -intervention treatment. This consensus also recommends the treatment principles of atomization inhalation in Buddine used for asthma bronchitis: acute seizures are similar to atomization inhalation treatment during the acute seizures of asthma; if they are suspected of asthma during the maintenance period, they can be treated as soon as possible. Essence In addition, based on 1 mg, 2 times/day, a 7 -day atomization inhale inhalation of Bu Di Neid’s pre -intervention treatment plan can reduce the risk of acute attacks.
For asthma pneumonia, consensus gives diagnosis and treatment methods and treatment principles. Asthma pneumonia is very similar to capillary bronchitis in terms of cause, pathogen, pathophysiology, and clinical manifestations, and it is difficult to identify clinical clinical. The difference is that capitis is more inter -quality inflammation, while asthma pneumonia is more serious. The alveolar exudation, the atomization inhalation of Bu Diende is preferred in the acute and ease period. In principle, the treatment is basically the same as the capillary bronchitis.
Asthma pneumonia is similar to similar treatment as capillary bronchitis. Studies have shown that atomization inhalation inhale inhalation of Bu Di Needi treatment improves symptoms and high efficiency. Moisturizing inhalation of Bu Di Naid is a preferred medication for asthma bronchitis/asthma pneumonia, improving symptoms, high efficiency, and reducing the risk of acute attacks in the future.