Top 10 causes of chronic cough in children.
Chronic cough is one of the common symptoms in children, but the diagnosis is not very easy because some tests are difficult to perform in young children. The diagnosis of the disease is facilitated by taking a medical history and a careful and thorough physical examination. If you 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, so that prevention and treatment can be more effective.
Clinical data show that the causes of chronic cough in children are in the following 10 categories.
1. Postnasal drip syndrome.
It is a reflex cough caused by upper respiratory tract infections, such as colds, rhinitis, sinusitis, etc. The nasal secretions formed by the postnasal tract flow into the posterior pharyngeal wall 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 pharyngeal examination, can help in the diagnosis if mucus or purulent secretions are found in the oropharynx. The key to treatment is to control the inflammation and eliminate the nasal lesions, and the cough symptoms can then disappear.
2. Cough variant asthma.
It is a special type of bronchial asthma with dry cough as the only symptom. It is characterized by chronic cough with little or no sputum, coughing day and night, aggravated by exercise, cold or inhalation of cold air, reversible airway obstruction on pulmonary function test, and positive bronchial excitation test with diagnostic significance. The treatment principle is the same as typical bronchial asthma, and glucocorticoids and albuterol aerosol inhalation therapy are effective.
3. Allergic cough.
It is an idiopathic allergic disease, clinically characterized by dry cough without wheezing and dyspnea, normal airway reactivity and normal chest X-ray examination, and will not develop into asthma, but may be accompanied by other allergic diseases. Treatment is based on glucocorticoids and anti-allergic drugs, without the use of bronchocontrol agents.
4. Eosinophilic bronchitis.
It is a chronic cough disease that is characterized by the absence of asthma, the absence of increased airway reactivity, the ineffectiveness of giving bronchodilators, and the effectiveness of giving glucocorticoids. It is characterized clinically by a dry cough with or without sputum, without wheezing, and increased eosinophils in the sputum and blood. Treatment principles are the same as for allergic cough.
5. Gastroesophageal reflux.
It is a dry cough caused by frequent reflux of gastric contents into the esophagus and irritation of the pharynx, accompanied by recurrent wheezing, paroxysmal dyspnea and other airway hyperresponsiveness symptoms. 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 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.
6. Tracheal and bronchial foreign bodies.
Children under 4 years old, especially boys, are active, curious and gluttonous, so they are prone to bronchial foreign bodies caused by accidental inhalation. The history of foreign body inhalation and sudden choking cough can be generally detected, followed by chronic coughing performance, pulmonary auscultation can be found on one side of the lung with reduced breath sounds, mediastinal oscillation can be seen on chest X-ray, and fiberoptic bronchoscopy reveals an airway foreign body is an important basis for diagnosis. The key to treatment is to remove the foreign body from the airway.
7. Pulmonary tuberculosis.
Children are at high risk for pulmonary tuberculosis. If children develop endobronchial tuberculosis, it can cause chronic cough. The clinical manifestations are chronic cough with symptoms of tuberculosis toxicity such as low fever, night sweats and wasting. Lung X-ray, sputum examination and fiberoptic bronchoscopy are important bases for diagnosis. Anti-tuberculosis chemotherapy is the key to treatment.
8. Infectious cough.
Infectious cough is a chronic cough caused after a 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.
9. 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 said to be quiet, with loud, harsh coughing sounds, and its cough often worsens when it is mentally unhappy or when it is reprimanded by parents. After ruling out other causes of coughing, psychological support and guidance can ease the symptoms.
10. Chronic bronchitis.
It is rare in children, but if children have bronchiectasis, there is an increased number of cases presenting as chronic bronchitis. The clinical features are chronic, with sputum or purulent sputum, and pulmonary X-rays reveal thickened and disturbed lung texture. The key to treatment is mainly anti-infection, cough suppression, expectoration and asthma.