In recent years, an increasing number of Mycoplasma pneumoniae pneumonia (MPP) cases that are resistant, severe, and even fatal have been reported[13]. The airway and lung lesions of some individuals with refractory MPP (RMPP) remain severe, even if the children's body temperature returns to normal after standard treatment. Confident children with RMPP suffer from problems, including atelectasis and pulmonary consolidation[14]. The bronchoscope has been widely used to diagnose and treat pediatric respiratory diseases. Among them, BLA fluid therapy is becoming in popularity [15]. The bronchoscope can reach the lesion directly during alveolar lavage, so not only can the secretions in the bronchus be aspirated, but also the drugs can be injected at the lesion, the treatment is targeted, which improves the clinical efficacy, and under the repeated flushing of alveolar lavage fluid, the mucous secretions can be diluted, which is more conducive to sputum discharge, effectively inhibit the toxin effect of pathogens,
Observation of clinical laboratory exams (WBC, CRP, ESR, LDH, SF), pulmonary imaging changes, clinical effectiveness, and the occurrence of adverse events before and after BLA with different drugs were the objectives of this research.
The overall time of bronchoscopic alveolar lavage therapy was shorter in the Acetylcysteine + budesonide group compared to the Budesonide and Ambroxol + budesonide groups, according to this research. Groups according to the overall length of treatment with various medicines. The difference between the budesonide and ambroxol + budesonide groups was not statistically significant. WBC, CRP, ESR, LDH, and SF levels decreased in all three groups after treatment, indicating that BLA may lessen the inflammatory response. The WBC, CRP, and ESR changes in the three groups after treatment were not statistically significant. The variations in LDH and SF, however, were statistically significant.
Tamura[16] observed that children with RMPP had elevated LDH and SF blood levels. Inamura et al.[17] believe that LDH, IL-18, and SF might be utilized to evaluate the therapeutic effectiveness of RMPP. Young-Jin Choi[18] revealed that LDH and SF might be a marker for children's RMPP treatment. According to the results of this study, the effects of BLA coupled with acetylcysteine + budesonide were superior to those of BLA mixed with budesonide alone or with ambroxol + budesonide. In terms of reducing serum LDH and SF, acetylcysteine and budesonide's effects are superior to those of cysteine and budesonide. Acetylcysteine may disrupt the disulfide bond of glycoprotein in sputum, prevent the activity of alveolar proteinase, break up mucus, and quickly dissolve viscous secretions. In addition, as an antioxidant, it may inhibit the generation of inflammatory factors, reduce the inflammatory response, and lessen mucosal stimulation, which is all useful for infection prevention. Budesonide is a corticosteroid with vigorous glucocorticoid activity and modest halo-corticoid activity that aids in the relief of bronchial mucosal congestion and edema. It inhibits mast cells, eosinophils, neutrophils, macrophages, and lymphocytes, among other cells and mediators. In combination with acetylcysteine, local effects are faster than intravenous medicines, decreasing the side effects of systemic hormone therapy, and lung inflammation may be reduced. The unknown is the specific mechanism of action of serum LDH and SF. It is the active metabolite of bromhexine in the patient's body, which ensures the mobility of mucus, improves the activity of tracheal cilia, reduces the secretion of sputum, and inhibits the accumulation of neutrophils, macrophages, leukotrienes, and other inflammatory cells and factors, thereby effectively reducing the inflammatory response of the body. During bronchoscopic alveolar lavage, it has been demonstrated to be inferior to acetylcysteine in decreasing inflammation. Further research is required to determine if this is because acetylcysteine is a nebulized medication with a low molecular weight, which makes it more likely to have an anti-inflammatory impact.
According to the results of this study, the clinical efficacy of combination lavage with acetylcysteine + budesonide was superior to that of budesonide alone or ambroxol + budesonide. The atomized dose form of acetylcysteine makes it easier to reduce sputum viscosity, dilute sputum, and make sputum easier to cough up than the intravenous infusion form of ambroxol injection. As a flushing solvent, ordinary saline was incapable of lowering sputum viscosity.
It is the active metabolite of bromhexine in the patient's body, which ensures the mobility of mucus, improves the activity of tracheal cilia, reduces the secretion of sputum, and inhibits the accumulation of neutrophils, macrophages, leukotrienes, and other inflammatory cells and factors, thereby effectively reducing the inflammatory response of the body. During bronchoscopic alveolar lavage, it has been demonstrated to be inferior to acetylcysteine in decreasing inflammation. Further research is required to determine if this is because acetylcysteine is a nebulized medication with a low molecular weight, which makes it more likely to have an anti-inflammatory impact.
Cough was the most common adverse reaction to BLA, followed by tachycardia or bradycardia, mild bleeding, bronchospasm, laryngeal spasm, dyspnea, sore throat, and decreased blood oxygen [19].
According to specialized studies, the rate of adverse events ranges from 5–35%, although serious adverse events are below 1% [20, 21]. According to this research, there was no significant difference in the occurrence of adverse responses between the three groups. The cough was the most prevalent side effect of BLA therapy, followed by an elevated heart rate. These side effects subsided after BLA was withdrawn, demonstrating that the combination of BLA and the other three medications was safe.
This research indicated that BLA might boost the early therapeutic Impact of RMPP, efficiently eliminate pathogens and thick respiratory tract secretions, as well as sputum embolism, consequently improving the recovery of small airway structure and function and decreasing hospital stays. BLA is affected differently by different drugs. BLA-coupled acetylcysteine and budesonide were more effective than ambroxol combined with budesonide and budesonide alone; hence, they are clinically applicable.