Doctor, my child has a cough, what is the best medicine to take? This is one of the questions that doctors are often asked. Just take some cough medicine. In the eyes of the patient, it seems that different people with coughs can be treated with the same medication. But in the eyes of a doctor this is not the case at all. To treat a cough well, you must first identify the cause of the cough, and treatment options are different for coughs caused by different diseases. There are many children who have recurrent coughs and have been treated in internal medicine for more than a month or two without improvement, and then they come to me in the ENT department only to find out that it is caused by a problem with their nose. What? A cough can be caused by a problem with the nose? Yes, you heard it right, this is something that many people don’t realize, not only the patients, but sometimes even some non- ENT doctors are not 100% aware of it. What does chronic cough mean? Chronic cough in children is defined as a cough that lasts longer than 4 weeks (adults with a duration of more than 8 weeks are defined as having a chronic cough) and can be divided into atopic and non-atopic coughs. An atopic cough is a cough that is accompanied by other symptoms or signs that are suggestive of a cause, i.e. cough is only one of many symptoms, such as inflammation of the lungs or bronchiectasis, if accompanied by pus sputum. Non-specific cough refers to a chronic cough in which cough is the main or only manifestation of the patient and no significant abnormalities are seen on chest radiographs. Atopic cough is easier to diagnose by physical examination by a physician or by laboratory tests. So today I will focus on non-specific chronic cough in children. What diseases can cause non-specific chronic cough in children? There are many diseases that cause non-specific chronic cough, the 3 most common ones are: cough variant asthma, upper airway cough syndrome and cough after respiratory tract infection. Cough variant asthma is the most common cause of chronic cough in children in China. It usually presents as a dry cough that often attacks at night and/or early in the morning and is aggravated by exercise and cold air, with no clinical signs of infection or after a long period of ineffective antimicrobial therapy. Upper airway cough syndrome is the 2nd leading cause of chronic cough in children and was formerly known as postnasal drip (flow) syndrome until 2006. The cough is more pronounced when waking up in the morning or when there is a change in position and is often accompanied by nasal congestion, runny nose, dry and itchy throat, foreign body sensation and repeated throat clearing. Coughing after a respiratory infection is also one of the more common causes of chronic cough in children. Usually there is a recent clear history of respiratory infection and in the recovery phase of the disease, the cough is irritatingly dry or accompanied by a little white mucous sputum and usually resolves spontaneously, with a cough duration of no more than 8 weeks. Parents usually bring their children to the internal medicine or respiratory department first for coughing, so cough variant asthma and cough after respiratory infection will be diagnosed at a relatively early stage and treated with standardized treatment. However, upper airway cough syndrome is often easily overlooked, or the cough does not improve after a period of internal medicine treatment before referral to ENT. What diseases can cause upper airway cough syndrome? Allergic (allergic) rhinitis, sinusitis, chronic pharyngitis, chronic tonsillitis, palatine tonsils and/or adenoid hypertrophy of the nasopharynx, nasal polyps and other upper airway diseases may cause chronic cough. If the cough is more pronounced in the morning when you wake up or when you change position, and is often accompanied by nasal congestion, runny nose, dry and itchy throat, foreign body sensation and repeated throat clearing, you should visit the ENT department early. What rhinitis and sinusitis can cause cough? There are 3 main reasons: 1. Nasal secretions can drip into the throat or trachea through the back nostrils, causing airway inflammation, which can lead to coughing. 2. Nasal and pharyngeal-bronchial reflexes cause coughing. When the nasal mucosa or pharynx is irritated by inflammation, the body will cough to keep the airways clean and clear. 3. High-speed exhalation during coughing exerts friction on the mucosal wall, which leads to airway inflammation. What tests are needed to make a definitive diagnosis? Diagnosis by ENT doctors needs to be aided by a number of tests, which include: anterior rhinoscopy, throat examination with tongue depressor, electronic nasolaryngoscopy, sinus CT, allergen testing, skin prick test, etc. Depending on the clinical presentation, the doctor will choose one or more of these tests for the child in order to make an accurate diagnosis and treat the disease. How is upper airway cough syndrome treated? Depending on the disease causing the child’s chronic cough, different treatment options are used: 1. Allergic rhinitis: treatment with antihistamines, nasal glucocorticoids, or a combination of nasal mucosal decongestants and leukotriene receptor antagonists. 2, sinusitis: sinusitis treatment is mainly nasal spray hormone therapy, supplemented by mucus pro-discharge agents, nasal irrigation. Chronic purulent sinusitis is treated with antibacterial drugs for at least 2 weeks. 3, adenoid hypertrophy: according to the degree of adenoid hypertrophy, mild to moderate can be nasal spray glucocorticoid combined with leukotriene receptor antagonist, treatment for 1 to 3 months and wait for observation, invalid can take surgery. Therefore, if your child has a cough that has been untreated for a long time (more than 4 weeks) and a chest x-ray shows no significant abnormalities, along with symptoms of discomfort in the nose and throat, it is important to visit the ENT department as soon as possible. Based on the results of the physical examination and laboratory tests, the doctor will determine the cause of the cough and provide regular treatment for the diagnosis of the disease. Another reminder. Therefore, parents must be patient and cooperate with the doctor and bring their children to follow-up appointments on time in order to achieve a more satisfactory treatment result.