Chronic cough is not very easy to diagnose in childhood and requires a detailed medical history, family history, and careful and thorough physical examination. If one can have an understanding of the common diseases that cause chronic cough in children and their clinical manifestations, it is easier to make a judgment about the cause based on symptoms, signs and necessary laboratory tests to make prevention and treatment more effective. Clinical data show that the causes of chronic cough in children are in the following 10 categories.
1. Bronchial asthma
Bronchial asthma is the most common cause of chronic cough in children, and it is especially easy to diagnose as “upper sensation”, “bronchitis”, “pneumonia”, and to use a lot of antibacterial, hormonal, phlegm-suppressing and cough-suppressing drugs or repeated hospitalization. The use of antimicrobials, hormones, phlegm, cough and other drugs, or repeated hospitalization.
2.Postnasal drip syndrome
It is a reflex cough caused by upper respiratory tract infection, such as cold, rhinitis, sinusitis, etc., in which nasal secretions flow into the posterior pharyngeal wall through the posterior nasal tract and stimulate the posterior pharynx. It is characterized by a chronic cough with or without sputum and is more severe at night and in the early morning. At the same time, the child has nasal congestion, feels as if something is dripping into the posterior pharyngeal wall, and needs to clear his throat frequently. Capturing the history of nasal inflammation and the characteristic manifestations mentioned above, combined with the pharyngeal examination, if mucus or purulent secretions are found in the oropharynx will help in the diagnosis. The key to treatment is to control the inflammation and eliminate the nasal lesions, and the cough symptoms can then disappear.
3. Cough variant asthma (CVA)
It is a special type of bronchial asthma with dry cough as the only symptom. Clinical features: most common in preschool and school-age children; persistent cough >4 weeks, with nocturnal and/or early morning attacks, aggravated by exercise and cold air; no signs of infection or ineffective with prolonged antibiotic treatment; significant relief of cough symptoms with bronchodilators; normal pulmonary ventilation; bronchial excitation test suggesting airway hyperresponsiveness; history of allergic disease (family history of drugs/diseases); positive allergen test ;; except for chronic cough caused by other diseases.
4. Allergic cough (AC)
It is an idiopathic allergic disease, clinically characterized by dry cough without wheezing and dyspnea, normal airway reactivity and normal chest X-ray, which does not develop into asthma, but can be accompanied by other allergic diseases. Treatment is based on glucocorticoids and anti-allergic drugs, without the use of bronchocontrol agents.
5. Eosinophilic bronchitis
It is a chronic cough disease that is not associated with asthma, without increased airway reactivity, and in which the administration of bronchodilators is ineffective and the administration of glucocorticoids is effective. It is characterized by a dry cough with or without sputum, without wheezing and with increased eosinophils in the sputum and blood. Treatment principles are the same as for allergic cough.
6. Gastroesophageal reflux
It is a dry cough caused by frequent reflux of gastric contents into the esophagus, which irritates the throat and is accompanied by recurrent wheezing, paroxysmal dyspnea and other airway hyperresponsiveness. The patient also has gastrointestinal symptoms such as acid reflux, eructation, vomiting, and heartburn. The diagnosis relies on the presence of wheezing, preceded or accompanied by acid reflux and heartburn, and links between the two, combined with positive 24-hour esophageal PH monitoring and effective treatment with experimental antacid therapy. The key to treatment is anti-reflux, and as reflux decreases its cough symptoms are reduced without the need for special anti-asthmatic medication.
7. Tracheal and bronchial foreign bodies
It is common in children under 4 years of age. Children are active, curious and gluttonous, which can easily cause bronchial foreign bodies by accidental inhalation. The history of foreign body inhalation and sudden choking cough can be generally detected, followed by chronic cough performance. The key to treatment is to remove the foreign body from the airway.
8.Tuberculosis
Children are at high risk of pulmonary tuberculosis, endobronchial tuberculosis, often with chronic cough as the main manifestation, which can be accompanied by symptoms of tuberculosis toxicity such as low fever, night sweats, and wasting, etc. Lung X-ray, sputum examination and fiberoptic bronchoscopy are important bases for diagnosis. Anti-tuberculosis chemotherapy is the key to treatment.
9. Infectious cough
Infectious cough is a chronic cough caused after respiratory virus or chlamydia or mycoplasma infection. Infectious cough is mainly seen in children under 5 years of age, with an incidence of 5%-8%, which is not uncommon. It is characterized clinically by the presence of symptoms of upper respiratory tract infection such as fever, sore throat, and runny nose before the onset of the cough, and after these symptoms have disappeared, the cough persists for up to 4 weeks or more. The key to treatment is the administration of cough expectorants with enhanced effects of glucocorticoids.
10. Psychogenic cough
Also known as psychogenic cough or habitual cough, it is mainly seen in school-age children and occurs after upper respiratory tract infections. It is characterized by a cough that decreases or disappears during play and sleep, but coughs when it is quiet, with a loud, harsh coughing sound, and is often aggravated when they are unhappy or reprimanded by parents. After excluding other causes of coughing, psychological support and counselling can help to relieve the symptoms.