Lin Meimei having a wheezing attack

This is the 5154th article of Da Yi Xiao Hu

Preface

Meimei just turned one last week. She spent the whole day in the amusement park to celebrate, but she started coughing the next day. Last night she suddenly coughed very violently, accompanied by a fever, and there were strange noises in her throat. This scared Meimei's mother, and she quickly took Meimei to the hospital.

Meimei's mother : Dr. Le, my daughter Meimei has been coughing for 4 days. It was not serious at first. We thought she was choking on her saliva. But she started to have a fever and cough very badly since yesterday. When she coughed, her face turned red and she was out of breath and looked very uncomfortable. I was so worried...

After listening to Meimei's mother's description, Dr. Le quickly performed a physical examination and found that wheezing could be heard in Meimei's lungs. So he quickly asked Meimei to complete a blood routine, respiratory pathogen, chest X-ray and other tests. The results showed that respiratory syncytial virus was positive (+), and the texture of both lungs increased.

Dr. Le : Meimei has never had similar wheezing symptoms before. Combined with the results of auxiliary examinations, this time she has bronchiolitis.

Meimei’s mother : I have only heard of bronchitis, what is bronchiolitis?

Dr. Le : Bronchiolitis is acute infectious bronchiolitis, one of the common respiratory diseases in pediatrics. It is mostly caused by respiratory syncytial virus infection and mainly occurs in infants under 2 years old. The main clinical manifestations are runny nose, cough, paroxysmal wheezing, shortness of breath, three-recess sign, prolonged expiratory phase on auscultation, audible wheezing and fine moist rales. The peak of epidemic in southern China is mainly in summer and autumn, while in the north it occurs in winter and spring. Every few years, there will be an outbreak of bronchiolitis caused by respiratory syncytial virus infection.

Meimei’s mother : In our daily lives, we pay great attention to personal hygiene, so how could we still be infected with upper respiratory syncytial virus?

Dr. Le : RSV is mainly transmitted through droplets, such as coughing, sneezing, and close conversation, as well as contact, such as contact with contaminated hands, toys, and daily necessities. Therefore, in addition to hand hygiene, we must also pay attention to wearing masks in public places and crowded places.

Meimei’s mother : So that’s why. My Meimei has always refused to wear a mask. It seems that she was infected in the amusement park this time. Is this disease very serious?

Dr. Le : Don't worry too much. The characteristics of bronchiolitis will cause the symptoms of wheezing to be more obvious, and the disease is more urgent. But Meimei's oxygen saturation is 98% at present, the three-recess sign is not obvious, her face is ruddy, and her lips are not cyanotic, indicating that there is no obvious hypoxia. Her mental state and appetite are also good. Active treatment will quickly improve her condition. However, the younger the child, the faster the disease changes, so we still need to closely observe the child's wheezing, coughing, mental state, appetite, etc. Usually, oxygen saturation below 92%, obvious three-recess sign, irritability or drowsiness, groaning, poor appetite, significantly increased or stopped breathing, etc. indicate that the condition is serious and needs to be treated or hospitalized as soon as possible.

Meimei’s Mom : Can bronchiolitis be cured?

Dr. Le : Although bronchiolitis is aggressive and causes obvious wheezing and shortness of breath, the prognosis is good, and most children can fully recover through active and effective treatment. However, if the child has an underlying disease (such as immunodeficiency, congenital heart disease), or is a premature baby, a low birth weight baby, or is less than 6 months old at the time of onset, the disease may develop into a severe one, and the prognosis is poor.

Meimei’s mother : How should I use the medicine?

Dr. Le : The treatment of bronchiolitis generally consists of bronchodilators, glucocorticoids, leukotriene receptor antagonists, and symptomatic antiviral and antibacterial treatments.

Meimei's mother : Are there any side effects of using hormones at such a young age? For example, not growing taller, gaining weight, etc.

Dr. Le : The first recommended hormone administration method for bronchiolitis is nebulized inhalation. Inhaled drugs act directly on the airway, and the dosage is smaller than oral or intravenous administration. In addition, hormones for such children are mostly used for a short period of time, and will not affect height and weight, nor will they cause side effects such as moon face. However, it is important to remind you to avoid contact between the nebulized liquid and the eyes to avoid eye discomfort. Remember to rinse your mouth and wipe your face in time after nebulization, otherwise you may experience hoarseness, oral fungal infection, etc.

Meimei’s mother : I have seen other children have undergone nebulization. Meimei is feeling so uncomfortable now, I want her to do it for a while longer!

Dr. Le : The longer the nebulization is done, the better the effect. The generally recommended nebulization time is about 15 minutes. The principle of nebulization is to use the nebulizer to disperse the liquid medicine into tiny droplets or particles, so as to achieve the purpose of humidifying the airway and relieving airway spasm. As the nebulization proceeds, the liquid medicine in the medicine storage tank is concentrated, and the aerosol particles are enlarged, resulting in a worse effect. Therefore, it is not advisable to extend the nebulization time indefinitely in pursuit of therapeutic effect.

Meimei’s mom : Does traditional Chinese medicine have any treatments for bronchiolitis?

Dr. Le : In addition to taking Chinese medicine decoctions according to syndrome differentiation, you can also use acupuncture points for cough and phlegm reduction. Grind rhubarb, scutellaria, almonds and other drugs into powder, mix them with ginger juice to make pills, and apply them to Tiantu, Dingchuan and other acupuncture points. The drugs can be absorbed through the skin to achieve the effect of cough and asthma. The external treatment method is simple, convenient, cheap, and effective, and is more friendly and safe for young children. In addition to acupuncture points in the acute stage, you can continue to use acupuncture points for strengthening the lungs and strengthening the foundation to increase the positive energy and resist the disturbance of evil after the disease prognosis.

Meimei’s mother : What should we pay attention to in our daily life?

Dr. Le : During a cough, you should eat a light diet and avoid ice cream, drinks, chocolate, candy, seafood, crabs, mushrooms, bamboo shoots, mangoes, pineapples, watermelons, and allergen-positive foods. Because bronchiolitis is common in infants and young children, new complementary foods should not be added during the illness. In addition, you should get enough rest and avoid strenuous exercise and temperature stimulation, such as running, ball games, swimming, etc.

Meimei’s mother : Oh, I heard from others that as long as you wheeze, it is considered asthma. We are so young, what should we do in the future?

Dr. Le : It is not rigorous to diagnose asthma based on a single wheezing attack. Bronchiolitis is a common wheezing disease in infants and young children, while asthma is a chronic inflammatory respiratory disease. However, about 22%-50% of children with bronchiolitis may develop airway hyperresponsiveness and abnormal lung function, followed by repeated wheezing attacks and eventually develop asthma. Therefore, the statement that "as long as you have wheezing, it is asthma" is incorrect, but children who have suffered from bronchiolitis must seek medical treatment in time in the early stages of respiratory infection in the future, and take medication as prescribed by the doctor to prevent repeated wheezing attacks.

Meimei’s mother : I see. Thank you Dr. Le for your detailed explanation. It has helped me understand a lot about bronchiolitis and I won’t be frightened blindly anymore!

Author : Le Lulin, resident physician in the Department of Pediatrics, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine. Research direction: diagnosis and treatment of children's growth and developmental diseases with traditional Chinese and Western medicine.

Article reviewer and column editor : Shen Jian, Director of Pediatrics, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Director of Child Health Center, Director of Teaching and Research Section of Integrated Traditional Chinese and Western Medicine Pediatrics, Subject Leader, Chief Physician, Doctor of Medicine. National TCM Inheritance and Innovation "Hundreds of Thousands" Talents of the Central Administration. Vice Chairman of the Child Development and Behavioral Science Committee of the World Federation of Chinese Medicine Societies, Vice Chairman of the Prescription and Drug Efficacy Research Branch of the Chinese Society of Ethnic Medicine, and Standing Committee Member of the Pediatric Professional Committee of the Shanghai Society of Integrated Traditional Chinese and Western Medicine.