Analysis Of A Case Of Intractable Wheezing And Review Of Literature

Objective: To summarize the clinical data of a child with intractable wheezing in order to improve the comprehensive and systematic understanding of children with intractable wheezing in bronchial asthma.Methods:The characteristics,clinical manifestations,auxiliary examination,diagnosis and treatment of a child with intractable wheezing were analyzed in detail,and the related literatures were reviewed.Results: The child coughed and wheezed repeatedly for 7 years.It was improved after repeated administration of anti-infective,intravenous or oral corticosteroids,and repeated after drug withdrawal.More than 7 years ago,the child developed cough and wheezing,improved after anti-infection and inhalation of bronchiectasis drugs,repeated after drug withdrawal,with exercise intolerance.Five years and six months ago,he was admitted to a third-class hospital in Beijing because of cough and asthma.The eosinophil and serum total Ig E were significantly higher than the normal value.He was discharged from the hospital after treatment with anti-infection,anti-allergy,hormone,atomization and deworming.Five years ago,the child was hospitalized in our hospital for the first time because of rash,cough and asthma,and improved after treatment.After discharge,there were still repeated attacks of cough and asthma,and then it was found that there were dead animals under the bed in the child’s bedroom,and the control of asthma tended to be stable after clearance.Three years and four months ago,the child was admitted to hospital again because of poor wheezing control.Chest CT showed annular high-density shadow in the upper lobe of the right lung,which was diagnosed as bronchial asthma,pneumonia and vulvar Candida vaginitis,which improved after treatment,and the drugs were basically the same as before.Four days after discharge,the child coughed and wheezed,and the condition was repeated under routine treatment such as antibiotic anti-infection and hormone antiasthma.circular or horseshoe-shaped disease appeared in chest CT.Considering fungal infection,allergic bronchopulmonary aspergillosis could not be excluded,and the child was discharged automatically.In the later stage,the children were followed up by telephone in a third-class hospital in Beijing,and the diagnosis was as follows: 1.Refractory asthma 2.Allergic bronchopulmonary aspergillosis? 3.Gastroesophageal reflux 4.Rhinitis,sinusitis.Obesity,after oral administration of hormone,antifungal,antiallergic,antiacid and inhaled antiasthmatic drugs,the condition improved,and the patients were followed up for 3 years,and cough and asthma were not repeated.Conclusion:Children with intractable wheezing have the characteristics of long course of disease,difficult to control wheezing and complicated etiology,while the condition of children with allergic bronchopulmonary aspergillosis is more complicated,and the etiological treatment of wheezing is very important.in clinical work,we should comprehensively analyze the clinical symptoms,auxiliary examination and disease evolution process,and actively look for the root causes of intractable wheezing.