bubble_chart Overview

Pneumonia lasting more than 3 months is considered chronic pneumonia. In recent years, the mortality rate of acute pneumonia in children has been decreasing. However, severe cases often fail to fully recover, and relapses or progression to chronic pneumonia are quite common. Therefore, timely prevention and treatment of chronic pneumonia are crucial.

bubble_chart Etiology

The factors contributing to chronic pneumonia include the following: ① Malnutrition, rickets, congenital heart disease, or subcutaneous nodules in children with pneumonia can lead to a prolonged course of the disease. ② Viral infections causing interstitial pneumonia are prone to evolve into chronic pneumonia. A follow-up study by the Capital Institute of Pediatrics on 103 cases of adenovirus pneumonia 1–5 years after the illness found that 30.1% showed varying degrees of chronic pneumonia and atelectasis on X-ray examination, with some children also exhibiting bronchiectasis. Among 13 cases of measles complicated by adenovirus pneumonia followed up 2–3 years later, 6 had developed chronic pneumonia. ③ Recurrent upper respiratory infections or bronchitis, as well as chronic sinusitis, are all predisposing factors for chronic pneumonia. ④ Foreign bodies lodged deep in the bronchi, particularly those that are non-irritating and do not cause initial-stage acute fever (such as date pits), may be overlooked and remain in the lungs for an extended period, leading to chronic pneumonia. ⑤ Immunodeficiency in children, including humoral and cellular immune deficiencies, complement deficiencies, and defects in leukocyte phagocytic function, can result in recurrent pneumonia episodes, eventually progressing to chronic pneumonia. ⑥ Primary or secondary abnormalities in the morphology and function of respiratory cilia can lead to chronic pulmonary inflammation.

bubble_chart Pathological Changes

Inflammatory lesions can invade bronchi at all levels, alveoli, interstitial tissues, and blood vessels. Particularly in interstitial tissue inflammation, each episode leads to progression, destroying the elastic fibers of the bronchial walls and eventually causing luminal narrowing due to fibrosis. At the same time, due to the obstruction of the lumen by secretions, atelectasis occurs, ultimately leading to bronchiectasis. The destruction of bronchial walls and alveolar septa allows air to spread through lymphatic vessels into the interstitial spaces, potentially forming interstitial lung qi swelling. Local blood vessels and lymphatic vessels also undergo proliferative inflammation, with thickened walls and narrowed lumens.

bubble_chart Clinical Manifestations

Chronic pneumonia is characterized by periodic recurrence and exacerbation, presenting a wave-like course. Symptoms vary widely depending on the stage of the disease, age, and individual differences. During the remission period, body temperature is normal, with no obvious signs and almost no cough, but panting may occur during running or climbing stairs. During exacerbation, it is often accompanied by pulmonary insufficiency, leading to cyanosis and dyspnea. Due to reduced lung capacity, diminished respiratory reserve, and shortened breath-holding time, it causes hyperventilation and impaired external respiratory function. Recovery after exacerbation is very slow, often with persistent sputum production, and may even lead to facial edema, cyanosis, chest deformity, and clubbing of fingers and toes. Due to {|###|}lung qi{|###|} swelling and pulmonary insufficiency, pulmonary circulation resistance increases, pulmonary {|###|}stirred pulse{|###|} pressure rises, and the right heart burden intensifies, potentially resulting in cor pulmonale within six months to two years. Liver dysfunction may also occur. Leukocyte counts increase, and erythrocyte sedimentation rate (ESR) shows grade II acceleration.

Chest X-rays reveal a honeycomb pattern in the lung markings of the middle and lower lung fields and hilar regions, along with small vesicular {|###|}lung qi{|###|} swelling, and may also show substantial inflammatory lesions. Symmetrical enlargement of bilateral hilar shadows can be observed. As the disease progresses, bronchiectasis, right ventricular hypertrophy, and protrusion of the pulmonary {|###|}stirred pulse{|###|} segment—signs of cor pulmonale—may appear on X-rays. In cases of cor pulmonale, electrocardiograms show clockwise rotation, tall and peaked P waves, and right ventricular hypertrophy patterns in most QRS complexes.

bubble_chart Diagnosis

In the diagnosis of this disease, medical history is extremely important. Patients often have a history of recurrent sinusitis, bronchitis, or pneumonia, or have previously suffered from measles, whooping cough, epidemic common cold, or adenovirus pneumonia. A definitive diagnosis requires a combination of disease history, symptoms, and filament examination.

bubble_chart Treatment Measures

The treatment of this condition requires long-term adherence to comprehensive measures. The key points of treatment are as follows:

(1) Strengthen nutrition: Provide a diet rich in nutrients and vitamins. Actively treat malnutrition and rickets.

(2) Physical exercise: Engage in regular outdoor activities or outdoor sleep. Perform exercises such as gymnastics, cold water rubs, or cold baths to enhance the body's cold tolerance. Indoor spaces should be well-ventilated to maintain fresh air. Actively prevent respiratory infections.

(3) Chinese medicine therapy: Primarily focuses on tonifying the whole body and restoring lung function. Refer to the sections on Chinese medicine therapy for bronchopneumonia and treatment during the convalescence stage of pneumonia.

(4) Clear focal infections: If complications such as sinusitis and bronchiectasis are present, appropriate treatment or surgical intervention should be undertaken.

(5) Other therapies: Nebulized inhalation of appropriate antibiotics, and the use of antibiotics to control infections in cases of recurrent infections. Adrenocortical hormones can inhibit hyperplasia and promote the resolution of lesions. Tianjin Children's Hospital once treated 5 cases with prednisone for 2 to 12 months, achieving good results. Additionally, physical therapies such as electromagnetic therapy, ultrashort wave diathermy, tuina, and mustard plasters can be used.

bubble_chart Prevention

The pathological recovery of acute pneumonia lags behind clinical recovery. Therefore, during the convalescence stage of severe pneumonia, physical therapy and exercise should be implemented, with active treatment for complications such as rickets and malnutrition. Follow-up and continued treatment after discharge should be maintained until full recovery is achieved. Additionally, measures should be taken to prevent measles, whooping cough, influenza, and adenovirus infections during infancy and early childhood. Chronic sinusitis and recurrent bronchitis should also be actively prevented and treated. For children with immunodeficiency, immunostimulatory therapy can be employed, selecting human gamma globulin, transfer factor, thymosin, or Chinese medicinals based on individual conditions. If necessary, bone marrow transplantation may be performed to restore immune function and prevent recurrent infections or the development of chronic pneumonia.

bubble_chart Differentiation

Special attention should be paid to the differential diagnosis of subcutaneous node disease. A history of recurrent upper and lower respiratory tract infections or prolonged pulmonary infections following pestilence, along with the discharge of purulent sputum, is commonly seen in chronic pneumonia. Subcutaneous node tests and X-ray examinations, revealing enlarged hilar and tracheobronchial lymph nodes, can aid in diagnosis.