Repeated respiratory infections get together during the school season. Experts remind you not to cough blindly.
"Why do children catch a cold as soon as they go to kindergarten?" "My child is a new junior one, and he has repeated respiratory infections from time to time, which has an impact on his study and life. How to enhance his immunity?" It’s the school season again, and children who get sick as soon as they go to school begin to make their parents nervous again. When the temperature changes suddenly every year, the number of small patients in the pediatric clinic of the hospital increases.
Experts from the First Hospital of Changsha City give advice to parents on how to prevent recurrent respiratory infections in autumn and let children spend their school life healthily.
A Why can’t a child catch a cold and root it?
Xiaolong, who has just been in kindergarten for a few months, is a lively and active child. He looks dignified and sturdy, but his mother always sighs. It turns out that after going to kindergarten, Xiaolong will "catch a cold" every once in a while, coughing, runny nose, etc., and sometimes he has a fever and even pneumonia twice. Xiaolong’s mother said helplessly that because she often went to the hospital, doctors and nurses in the hospital pediatrics became "familiar faces".
Xiaolong takes some oral drugs or fluids in the hospital for a few days at a time, and he will get well soon, but he always feels that he can’t cut off his roots. Because he is often sick, he has to ask for leave from the kindergarten teacher. Xiaolong’s mother said worriedly, "When I was born, I heard from the older generation that when the child is older, my body will be better after I was 3 years old. How can I get sick when I go to kindergarten now, and I run to the hospital one after another, worrying about the side effects of drugs, no matter how worried he is about the aggravation of symptoms or even pneumonia?"
Mei Mei, a new junior high school student, had a general physique when he was a child. With the aggravation of study tasks, he studied longer and longer every day. Sometimes he did his homework until late and had symptoms of respiratory infection from time to time. Mei Mei’s parents want to enhance her immunity. Some people say that it is good to drink oral liquid, while others say that Chinese patent medicine is good. Mei Mei’s mother doesn’t know whether her child can take immunomodulators, which is very tangled.
B The diagnostic criteria of recurrent respiratory tract infection are different at different ages.
What exactly is recurrent respiratory infection? What are the causes of recurrent respiratory infections? How should parents and children treat and prevent it?
According to the chief physician Wang Xiangyun, director of pediatrics department of Changsha First Hospital, respiratory tract infection is the most common disease among children. According to statistics, every child in developing countries suffers from 4.2 ~ 8.7 respiratory tract infections every year, most of which are upper respiratory tract infections, and the incidence of pneumonia is 10 times per 100 children every year. Respiratory tract infection is divided into upper respiratory tract infection and lower respiratory tract infection. Upper respiratory tract infection is a general term for inflammation of nasal cavity, pharynx or larynx, and it is also commonly diagnosed with terms such as cold, rhinitis, pharyngitis, nasopharyngitis and tonsillitis, which is referred to as "upper sensation" for short. Lower respiratory tract infection refers to tracheobronchitis and pneumonia. The onset is mostly acute, and the only mild symptoms are nasal symptoms, such as runny nose, stuffy nose, sneezing, tears and throat discomfort. If the infection involves the nasopharynx, there are often fever, sore throat, tonsillitis, congestion and hyperplasia of lymphatic tissue in the posterior pharyngeal wall, and sometimes lymphadenopathy. There are also some manifestations of vomiting and diarrhea, which are more common in infants and children, and are clinically called "gastrointestinal cold". In severe cases, there may be persistent high fever, frequent cough, shortness of breath, poor mental health, and severe systemic symptoms.
Recurrent respiratory tract infection means that the frequency of respiratory tract infection is too frequent in one year, exceeding a certain range. Different ages have different diagnostic criteria, which can be divided into repeated upper respiratory tract infections and repeated lower respiratory tract infections. Repeated upper respiratory tract infection refers to the infection of infants under two years old ≥ Seven times a year, children aged 2-5 years old were infected with ≥ Six times a year, children aged 5-14 were infected with ≥ 5 times/year; Repeated lower respiratory tract infections include repeated tracheobronchitis and repeated pneumonia. Repeated tracheobronchitis refers to the infection of infants under 2 years old ≥ Three times a year, children aged 2-5 were infected with ≥ Twice a year, children aged 5-14 were infected with ≥ 2 times per year; Repeated pneumonia, regardless of age, as long as it is infected ≥ It can be diagnosed twice a year. The interval between two infections is at least 7 days.
C blindly pursuing cough relieving effect aggravates the condition.
Wang Xiangyun said that there are many reasons for recurrent respiratory infections, including the following aspects.
Immature or low immune function: children are in the period of growth and development, and their immune function is obviously different from that of adults. Most of them are immature or low, even at different ages. For example, the content of immunoglobulin IgA is almost zero at birth, and it only approaches the adult level when it is 11 ~ 12 years old. Among them, secretory IgA is the main immunoglobulin in respiratory secretions, which plays an important role in the first line of anti-infection defense, so children are more prone to respiratory infections.
Improper nursing: After suffering from respiratory infection, many parents are worried that it is caused by catching cold, knowing that the weather is hot, or letting their children wear more clothes, resulting in high fever. Wipe the whole body with alcohol after fever, which may lead to alcoholism or allergies; Some parents blindly pursue the effect of relieving cough, but use antitussive drugs, which leads to sputum secretion not being discharged, but aggravates the condition.
Admission to nursery institutions, initial stage of enrollment and environmental factors: nursery institutions and schools are a public environment, and children are not used to school just now, so they can’t adapt to the changes of the environment well, and there are many children. When one person catches a cold, other children don’t know how to prevent themselves, and they are in close contact with each other, which is easy to cross-infect. The northern part of China is in the cold and changeable winter and spring season, while the southern part is more likely to cause respiratory tract infections in the rainy season with high humidity in summer and autumn. At the same time, air pollution, passive smoking and other environmental factors can lead to repeated respiratory infections.
Unbalanced nutrition: Some children are partial to food, picky eaters and anorexia, which leads to unbalanced nutrition, and they are more prone to respiratory infections than other children.
Chronic focus and basic diseases: Some children are more prone to recurrent respiratory infections than normal children because of chronic focus such as rhinitis, sinusitis and chronic tonsillitis, and basic diseases such as congenital immunodeficiency.
D treating virus-infected people without abusing antibiotics.
The purpose of clinical treatment is to reduce the number of respiratory tract infections.
The first is to find the cause and treat the underlying diseases. The most common pathogenic factor of recurrent upper respiratory tract infection in children is pathogen invasion, and the most common are viruses, bacteria and atypical pathogenic microorganisms. Anti-infection treatment for pathogens should not abuse antibiotics for highly suspected virus-infected people, and at the same time strengthen the treatment of basic diseases.
Secondly, immunomodulator therapy can be performed. The use of immunomodulators can enhance the immune function of respiratory tract, effectively reduce the frequency of recurrent respiratory tract infections and the use of antibacterial drugs.
Third, we must do symptomatic treatment. According to different age and illness, we should correctly choose expectorant, antiasthmatic, antitussive and other drugs, atomization therapy, lung posture drainage and lung physical therapy.
In addition, vaccination can be carried out reasonably; Strengthen nutrition, reasonable diet, supplement trace elements and vitamins; Arrange study and life reasonably, adjust the schedule of work and rest, pay attention to the combination of work and rest, not be overtired, and take appropriate outdoor activities and exercise to enhance physical fitness; Avoid passive smoking and odor stimulation, and keep the indoor air fresh.
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These tests are needed to identify recurrent respiratory infections.
Detection of pathogenic microorganisms: it is suggested to actively improve the joint detection of pathogens to determine what kind of pathogen infection it is. For example, anti-streptolysin O can be checked by blood sampling, which is the most common bacterium that causes tonsil suppuration; Nasopharyngeal swab examination of adenovirus and influenza virus antigen further clarified the cause of respiratory tract infection.
Otolaryngology examination: Some congenital developmental abnormalities and acute and chronic otorhinolaryngology infection foci such as adenoid hypertrophy and allergic rhinitis can be found directly through preliminary otolaryngology examination or nasopharyngeal laryngoscope.
Determination of immune function: primary and secondary immunodeficiency diseases can be found through detection of humoral immune function and cellular immune function. For example, selective IgA deficiency can lead to repeated respiratory infections.
Chest X-ray, lung CT and airway and vascular reconstruction: It can effectively find out the location of lung lesions, whether there are abnormal airway and lung development, airway stenosis, bronchiectasis, vascular compression and so on.
Bronchoscopy: The foreign body in the airway, airway obstruction and external tracheal compression, airway dysplasia and bronchiectasis can be diagnosed directly under the microscope.
Color Doppler echocardiography can provide diagnostic reference for recurrent respiratory tract infection caused by congenital heart disease.
Special examination: for example, if you suspect that you have primary ciliary dyskinesia, which leads to repeated cough and expectoration, you can perform respiratory mucosa biopsy to observe ciliary structure and function.
What kinds of immunomodulators can be used in children with recurrent respiratory tract infections and what are their contraindications?
First, immune system products
1. Thymosin: It can be used for the treatment of repeated respiratory tract infections caused by various primary or secondary T-lymphocyte deficiency diseases, and it is forbidden for allergic people.
2. Poly-myocyte: used for adjuvant treatment such as recurrent respiratory tract infections, and it is forbidden for allergic people.
Second, the chemical synthesis agent
1. Levamisole tablets: used for immunomodulation treatment of children’s recurrent respiratory tract infections, allergic rhinitis, allergic cough, bronchial asthma, atopic eczema and chronic urticaria, etc. It is forbidden for patients with liver and renal insufficiency.
2. Cimetidine: used as adjuvant therapy for allergic diseases, some refractory autoimmune diseases, recurrent respiratory infections, oral ulcers, etc. It is forbidden to use with central anticholinergic drugs at the same time, and it is forbidden to patients with severe heart and respiratory diseases, liver and renal insufficiency and organic encephalopathy. It is not recommended for children under 3 years old.
Iii. Biological agents
1. Bestin: used for the treatment of children’s recurrent respiratory infections and the immune regulation of abnormal diseases. It is not recommended for children with primary phagocytosis or humoral immune deficiency and infants under 1 year old.
2. Pantotrichum: It is suitable for the prevention and adjuvant treatment of recurrent respiratory infections, acute respiratory infections and allergic diseases. Allergic to pantothenic protein, autoimmune diseases (caused by antigen-antibody complex related to bacterial infection),
3. Transfer factor: it is suitable for adjuvant treatment of recurrent respiratory tract infections, infectious diseases, allergic diseases and autoimmune diseases. Allergy is forbidden.
4. BCG polysaccharide nucleic acid: used for preventing and treating recurrent respiratory tract infections, bronchial asthma, recurrent eczema, urticaria and other diseases. It is forbidden for people who are allergic to this preparation, patients with tuberculosis infection, other acute infectious diseases (such as measles, whooping cough, pneumonia, etc.) and children with acute infection.
5. Intravenous injection of human immunoglobulin (IVIG): In addition to primary and partial secondary immunodeficiency diseases, it can be used for some diseases related to autoimmune response such as premature delivery infection and intractable epilepsy, and plays an immunomodulatory role. It is forbidden to those who are allergic to IVIG or have other severe allergic history, and those who have selective IgA deficiency of anti-IgA antibody.
Iv. immunomodulators derived from plant medicines
1. Yupingfeng Granule: Allergic diseases such as allergic rhinitis, allergic cough, bronchial asthma, atopic eczema and chronic urticaria in children. In addition, it can be used as an immunomodulator for children with autoimmune diseases with local and systemic secondary immune dysfunction caused by long-term inhalation or oral corticosteroids. Use with caution during acute infection and fever.
2. Fuganlin oral liquid: repeated respiratory infections, cough variant asthma, and viral respiratory infections secondary to treatment with immunosuppressants. This medicine has no special contraindication.
3. Huangqi Granule: allergic diseases such as allergic rhinitis and bronchial asthma in children. In addition, autoimmune diseases with low immune function caused by oral corticosteroids, especially children with nephrotic syndrome, can be used as immunomodulators. Patients with cold and fever, acute infection and diabetes are forbidden to take it. (Xu Yuan Hoang Cam Instructor Wang Xiangyun, Director and Chief Physician of Pediatrics, Changsha First Hospital)