支气管炎儿童怎样治疗

支气管炎儿童如何治疗配图，仅供参考

4. Treatment
# 4.1. Bronchodilator
Short-acting and rapidly acting β2-agonists are the most popular and most commonly used first-line bronchodilators used to treat acute symptoms including wheeze,cough,and shortness of breath. Furthermore,these drugs have been shown to be more effective than placebos in controlling acute wheezing in children younger than 2 years but may not achieve clinically significant improvements . However,the presence of wheeze alone with no other condition may be best treated with observation alone or investigation of the potential underlying cause. Therapies can be initiated if wheeze is associated with increased difficulty in breathing . If the patient is young (less than 6 months old),the best option is referral to a tertiary center for a detailed evaluation . If the baby is more than 6 months old,two main factors should be considered: whether the patient is atopic and the severity of the wheeze episode.
If the severity is mild,bronchodilator therapy with a metered-dose inhaler is the preferred approach; a nebulizer is an alternative way to deliver medication,but children with atopy are more likely to respond to a bronchodilator.
If the baby has a moderate or severe type of wheezing,then the patient should be referred to a hospital for further management. Physicians should be aware that wheezy children do not display optimal responses to a bronchodilator,and the currently available evidence is too weak to suggest the use of bronchodilators as a routine treatment in the way they are used in asthmatic patients .
# 4.2. Inhaled steroids
Inhaled steroids can be used in recurrent wheeze in the presence of positive indicators with careful monitoring of efficacy. This treatment is effective in persistent and late-onset wheezing,but it is not as effective in transient wheezing,in which its effects are similar to those observed in viral-induced wheeze .
# 4.3. Systemic steroids
Systemic steroids can be used to treat wheezy patients,in whom a short course of therapy (3–5 days) has been documented to be effective in reducing recurrent wheeze after a rhinovirus infection in patients with eczema .
# 4.4. Antileukotriene
Montelukast (4 mg) granules are effective in treating postviral wheezing; however,a systemic review of antileukotrienes showed that they remain a weak treatment option and are therefore recommended as a routine measure that provides a modest benefit,with therapeutic trials of montelukast ranging from 1 to 3 months .
# 4.5. Summary of treatment
[Table 4](https://ncbi.nlm.nih.gov/pmc/articles/PMC6676316/table/tbl4/) summarizes the step approach to treatment of wheezy chest.
# Table 4
Step approach in wheezy chest.


Atopic background
Nonatopic background



First attack: step 2
First attack: step 1


Second attack: step 3
Second attack: step 2


Third attack: step 4
Third attack: step 3



[Open in a separate window](https://ncbi.nlm.nih.gov/pmc/articles/PMC6676316/table/tbl4/?report=objectonly)
Step 1: Ventolin PRN.
Step 2: Ventolin PRN and oral steroid.
Step 3: Ventolin PRN,oral steroid and a mild dose of inhaled steroid/singulair.
Step 4: Ventolin PRN,oral steroid,and a moderate dose of inhaled steroid/singulair.
# 4.6. Other medications
4.6.1. Antibiotics
There is no justification for the routine use of antibiotics because viruses are the main causes of infections of the respiratory tract. Antibiotic use in infancy may increase the risk of asthma by changing the flora,although azithromycin may be justified in children of preschool age with severe types of wheeze who are at risk of admission . Protracted bacterial bronchitis is a common cause of wet and chronic coughs. Recently,clinicians have become more aware of this condition,as there is strong evidence indicating that these patients have rates of wheeze as high as 90% and may respond to prolonged antibiotic use or other modalities .
4.6.2. Palivizumab
Monoclonal antibodies can be used to prevent RSV in high-risk groups,such as premature babies or patients with congenital heart disease and chronic lung disease; for example,Simoes and his group found that palivizumab significantly reduced the recurrence of wheezing in premature babies.
4.6.3. Ipratropium bromide
Inhaled ipratropium was found to be potentially beneficial in older children,but there is no good evidence that it is beneficial in children of preschool age .
4.6.4. Antihistamine
Antihistamines have been studied in children of preschool age with wheeze. Bassler et al. concluded that children treated with ketotifen were 2.4 times more likely than those treated with placebo to reduce or stop their bronchodilator treatment.
# 4.7. Parental level of education
The level of education of a patients parents is a very important factor in the management of children with wheeze because it affects the parents knowledge and understanding of wheezing disorders in children of preschool age,and children with parents who cannot understand their childs condition often receive inadequate treatment. Furthermore,few studies have focused on this issue,and multiple teaching sessions are recommended to increase family satisfaction .","department":"