Interpretation 1
Time frame criteria for diagnosis
Cough symptoms for more than 4 weeks, which is consistent with the criteria of the American College of Chest Physicians. The unification of criteria will facilitate future summary and analysis of pediatric chronic cough data as well as domestic and international communication.
Interpretation 2
Etiology varies by age
Common etiologies in infancy (<1 week of age) include respiratory infections and post-infectious cough, congenital tracheal and pulmonary developmental abnormalities, gastroesophageal reflux, tuberculosis, and other congenital cardiothoracic anomalies, with congenital disorders being a special point for children in this age group. Early childhood (1 to 1 year old) focuses on upper airway cough syndrome, cough variant asthma, airway foreign bodies, gastroesophageal reflux, and tuberculosis, in addition to respiratory infections and post-infection cough.
In the preschool period (3 to 12 years of age), bronchiectasis must be considered on top of this. In school age (6 weeks to prepubertal), cardiac cough is added as a factor; in adolescence, as in adults: asthma and related diseases (including cough variant asthma and eosinophilic bronchitis), sinusitis and upper airway cough syndrome, and gastroesophageal reflux are the three main diseases that cause chronic cough.
Interpretation 3
The Guidelines provide diagnostic clues
Respiratory tract infections and post-infectious cough.
1. A clear history of recent respiratory tract infection.
2. Cough is irritatingly dry or with a small amount of white mucous sputum.
3. No abnormalities on chest X-ray.
4. Normal pulmonary ventilation function.
5. Cough is usually self-limiting. If the cough lasts for more than 8 weeks, other diagnoses should be considered.
Cough variant asthma.
1, Persistent cough often attacks at night and/or early in the morning, and the cough worsens after exercise and exposure to cold air, with no clinical signs of infection.
2. Diagnostic treatment with bronchodilators may result in significant relief of cough symptoms.
3, Bronchial excitation test suggests airway hyperresponsiveness.
4, A history of allergic disease and its positive family history. Positive allergen testing may aid in the diagnosis.
Upper airway cough syndrome.
1. The cough is worse in the early morning or when the position is changed, often accompanied by nasal congestion, runny nose, dry throat, foreign body sensation, repeated clearing of the throat, and a few children complain of headache, dizziness, and low fever.
2. There may be pressure pain in the sinus area, yellowish-white discharge from the sinus opening, follicular hyperplasia in the posterior pharyngeal wall, cobblestone-like, and sometimes mucus-like attachment to the posterior pharyngeal wall.
3, antihistamines and leukotriene receptor antagonists, nasal glucocorticoids and other effective.
4. In cases caused by sinusitis, corresponding changes are seen on sinus X-ray plain or CT films.
Gastroesophageal reflux cough.
1. Paroxysmal cough, mostly occurring at night.
2. The cough mostly appears after eating and drinking, and feeding is difficult. Some children have upper abdominal or subxiphoid discomfort and burning sensation behind the sternum.
3.In addition to causing cough, infants can also cause asphyxia.
4.It can lead to delayed growth and development of the affected children.
Eosinophilic bronchitis.
1.Irritating cough.
2, Normal chest X-ray, normal pulmonary ventilation, no airway hyperresponsiveness.
3, Relative percentage of eosinophils in sputum > 3%.
4. Effective oral or inhaled glucocorticoid therapy.
Psychogenic cough.
1, Older children.
2. Daytime cough is predominant and disappears when focusing on something or resting at night.
3. Often accompanied by anxiety symptoms.
4. Without organic disease, psychogenic cough can only be diagnosed when tic disorders are excluded and the cough improves after behavioral intervention or psychotherapy.
Interpretation 4
Diagnosis of chronic cough in children
Detailed history taking, careful physical examination, and routine chest X-ray are basic. The Guidelines list various tests including pulmonary ventilation function, bronchial excitation tests, sinus CT films, bronchoscopy, cytology of induced sputum or bronchoalveolar lavage fluid and isolated culture of pathogenic microorganisms, tuberculin skin test, serum total and specific IgE assay, skin prick test, 24-hour esophageal pH monitoring, etc.
However, it does not mean that every child with chronic cough needs to have these tests. The Guidelines have prepared a practical diagnostic flow chart with the aim of providing pediatricians with a sequential approach to diagnosis, from simple to complex and from common to rare diseases. Finally, in the absence of clear etiologic hints, the principle of diagnostic treatment is to proceed in the order of upper airway cough syndrome, cough variant asthma, and gastroesophageal reflux cough.
Interpretation 5
Principles of management and therapeutic use
Emphasis is placed on identifying the cause of the disease and treating it for that cause. The expectations of the child’s parents should be attended to and taken into account. If the etiology is unknown, empirical symptomatic treatment can be administered first, but if the cough symptoms do not resolve after treatment, it should be re-evaluated. Cough suppressants should not be used in infants. The Guidelines emphasize the importance of post-treatment follow-up and re-evaluation, i.e., watch, wait and follow up.
Chronic cough with sputum should be treated as expectorant and not as a simple cough suppressant. H1 receptor antagonists such as chlorpheniramine, loratadine and cetirizine can be used to treat upper airway cough syndrome. Antimicrobial drugs can be considered for chronic cough with definite bacterial or mycoplasma or chlamydia infection. Calming anti-inflammatory drugs include glucocorticoids, 2-agonists, M-blockers, leukotriene receptor antagonists, theophylline and other drugs, mainly used for cough variant asthma and eosinophilic bronchitis.
Gastric stimulants such as domperidone can be used in children with gastroesophageal reflux cough. Cough suppressants are not recommended for chronic cough especially before the cause is clearly identified, and codeine is prohibited for the treatment of all types of cough. The sedative effect of promethazine (finasteride) may mislead parents to overlook the adverse effects of the drug, including irritability, hallucinations, abnormal muscle tone, and even apnea and sudden death.WHO warns that promethazine should not be used as a cough suppressant in children under 2 years of age.
Explanation 6
Non-pharmacological treatment needs attention
Non-pharmacological treatment measures include: avoidance of allergens, exposure to cold, smoke, including passive smoking; nasal irrigation with saline for sinusitis; postural changes, change of food properties, small and frequent meals for GERD cough; prompt removal of foreign bodies from the airway; discontinuation of medication for drug-induced cough; and psychotherapy for psychogenic cough. These non-pharmacological treatments are actually highly targeted etiological treatments.