I. Acute cough
The common cold is the most common cause of acute cough. Other causes include acute bronchitis, acute sinusitis, allergic rhinitis, acute attacks of chronic bronchitis, and bronchial asthma (asthma for short).
Treatment of common cold: symptomatic treatment is the mainstay, and antibacterial drugs are generally not required.
(1) Decongestants: pseudoephedrine, etc.
(2) Antipyretic drugs: antipyretic and analgesic drugs.
(3) Anti-allergic drugs: first-generation antihistamines.
(4) Cough suppressants: central cough suppressants, traditional Chinese medicine, etc.
Clinically, compound preparations of the above drugs are usually used. First-generation antihistamines + pseudoephedrine are preferred for treatment, which can effectively relieve symptoms such as sneezing and nasal congestion. Central cough suppressants, such as dextromethorphan, are used for obvious cough. Frequent pediatric drugs such as Echoconazole, Huifenesin, Day & Night Pepcid, etc.
II. Subacute cough (post-cold cough)
The most common causes are post-cold cough, bacterial sinusitis, asthma, etc. When the symptoms of the acute phase of the cold itself disappear and the cough still persists, it is clinically called post-cold cough. In addition to respiratory viruses, other respiratory tract infections may also cause this type of cough, which is collectively referred to as postinfectious cough in the literature. The pathogenesis and nature of post-infectious cough is still unclear, but it does occur clinically and is so common that it is included as a cause of cough in both Chinese and European and American guidelines.
Patients present with an irritating dry cough or a small amount of white mucus sputum, which can last for 3-8 weeks or even longer. Post-cold cough is often self-limiting and usually resolves on its own.
Due to the lack of specific clinical symptoms and objective examination indicators, post-cold cough is still mainly a diagnosis of exclusion, provided of course that the cough is post-cold, the cough has a history of prolonged cough and antibacterial medication is ineffective.
Central cough suppressants, first-generation antihistamine H1 receptor antagonists, etc. can be applied for a short time to some chronic prolonged coughs.
III. Chronic cough
Chronic cough has more causes and can usually be divided into two categories. One category is those with clear lesions on initial X-ray chest radiographs, such as bronchitis and pneumonia. The other category is those who have no obvious abnormalities on X-ray chest radiographs and whose cough is the main or only symptom, which is usually referred to as chronic cough of unknown origin (hereinafter referred to as chronic cough). The common causes of chronic cough are: cough variant asthma, postnasal drip syndrome, eosinophilic bronchitis and gastro-oesophageal reflux cough. Other etiologies include, for example, endobronchial tuberculosis, allergic cough and psychogenic cough.
1. Gastro-esophageal reflux cough (GERC): Typical reflux symptoms are retrosternal burning sensation, acid reflux, belching, and chest tightness. GERC patients with trace aspiration are more likely to have cough symptoms and throat symptoms in the early stage. Clinically, there are also many GERC patients without reflux symptoms, and cough is their only clinical manifestation.
Treatment.
(1) Lifestyle modification
(2) Acid-control drugs: Proton pump inhibitors (such as omeprazole or other similar drugs) or H2 receptor antagonists (ranidipine or other similar drugs) are often used.
(3) Gastric stimulants: such as domperidone, etc.
(4) Any patient with underlying gastroduodenal disease with H. pylori infection should be treated accordingly.
(2) Postnasal drip syndrome (PNDs): This is a syndrome in which secretions flow backwards into the postnasal and pharyngeal areas, or even backwards into the vocal cords or trachea due to nasal diseases, resulting in a cough as the main manifestation.
Treatment – depending on the underlying disease causing PNDs
First-generation antihistamines and decongestants are preferred for PNDs due to the following etiologies.
(1) non-allergic rhinitis.
(2) vasodilatory rhinitis.
(3) year-round rhinitis.
(4) Common cold. The first generation of antihistamines is represented by chlorpheniramine maleate and the commonly used decongestant is pseudoephedrine hydrochloride. Most patients develop efficacy within a few days to two weeks after initial treatment.
Various antihistamines are effective in the treatment of allergic rhinitis, and second-generation antihistamines without sedative effects are preferred, with commonly used drugs such as loratadine.
Nasal inhalation glucocorticoids are the drug of choice for allergic rhinitis, usually beclomethasone propionate or equivalent doses of other inhaled glucocorticoids. Sodium cromoglycate inhalation also has a good preventive effect on allergic rhinitis. In addition, environmental improvement and avoidance of allergenic stimuli are effective measures to control allergic rhinitis. Allergen immunotherapy may be effective, but has a long onset of action.
Antibacterial drugs are the mainstay of treatment for acute bacterial sinusitis. Nasal inhalation of glucocorticoids and decongestants may be used to reduce inflammation when results are poor or secretions are high.
For the treatment of chronic sinusitis, the following primary treatment regimen is recommended: application of antibacterial drugs effective against gram-positive, gram-negative, and anaerobic bacteria; oral first-generation antihistamines and decongestants; nasal decongestants; and nasal inhaled glucocorticoids. Negative pressure drainage, puncture drainage or surgery is feasible when internal treatment is not effective.
3. Eosinophilic bronchitis (EB): a non-asthmatic bronchitis characterized by airway eosinophil infiltration, which is an important cause of chronic cough.
Treatment: EB responds well to glucocorticoid therapy, resulting in disappearance or significant reduction of cough, significant decrease in sputum Eos count, and decreased cough sensitivity. If bronchodilator therapy is ineffective, glucocorticoids combined with H1 receptor antagonists also work well. It is usually treated with inhaled glucocorticosteroids. It is now believed that EB, CVA and asthma may be essentially the same, and EB may be an earlier stage of the disease, for which early treatment may prevent its development into asthma. Since the symptoms are long lasting and the sputum Eos and ECP rise and fall dynamically as the disease changes, it is suggested that it is a chronic problem and may require long-term treatment, for which treatment for at least 6 months is recommended.
4. Cough variant asthma (CVA): CVA is a specific type of asthma in which cough is the only or main clinical manifestation without obvious signs or symptoms such as wheezing and shortness of breath, but with airway hyperresponsiveness. A confirmed diagnosis of cough variant asthma requires regular application of asthma calming therapy for more than 3 months. The exact course of treatment needs to be determined on a case-by-case basis. Therefore, some patients need long-term maintenance treatment with low doses of medication. Even after discontinuation of the medication, prompt treatment is needed once an exacerbation manifests itself. Patients diagnosed with CVA should be given long-term inhalation therapy with hormones in the hope of completely controlling their symptoms and interrupting their progression to classic asthma. Steroid inhalation therapy can be effective in relieving cough symptoms in patients with CVA. In patients with infrequent or intermittent episodes of CVA, symptom control can be achieved with bronchodilators alone. Long-acting β2 agonists are commonly used because they act mainly on the central airway, reducing the afferent impulses of its tractor receptors and attenuating the cough reflex. The new generation of long-acting β2 agonists can effectively control nocturnal cough by significantly improving PEFR and sleep quality at night.
5. Bronchial asthma: Asthma is a chronic airway inflammatory disease, a chronic inflammatory response related to airway remodeling, the result of a combination of genetic and environmental factors, and the essence of its pathophysiology is chronic nonspecific inflammation of the airways. Due to the presence of airway inflammation, the clinical manifestations are airway variability airflow obstruction and airway hyperresponsiveness, and several studies have confirmed that asthma is a cause of chronic cough in all age groups.
Treatment: Inhalation of β2 agonists or oral aminophylline can provide transient relief of cough, but the most effective treatment is glucocorticoids, which can be administered orally followed by inhalation or inhaled glucocorticoids alone if symptoms are very severe, and can also be combined with inhaled β2 agonists to relieve acute symptoms. In a few cases, cough variant asthma is only effective with high doses of oral hormones, and most patients can significantly relieve their symptoms with small doses of inhaled hormones.
6. Psychogenic cough: Psychogenic cough is caused by patients with serious psychological problems or intentional throat clearing, and is also referred to by some authors as habitual cough and psychogenic cough. It is relatively common in children and typically presents as a daytime cough that disappears when the patient focuses on something and rests at night, often accompanied by anxiety symptoms.
The diagnosis of psychogenic cough is an exclusive diagnosis, and it can only be considered after other possible diagnoses have been excluded. The main treatment for psychogenic cough in children is suggestive therapy, which can be supplemented by short-term application of cough suppressants. In older patients, psychological counseling or psychiatric intervention can be supplemented with appropriate anti-anxiety medication.
V. Clinical experience with cough medication
1. The condition of the baby changes rapidly after the disease, but with proper treatment, recovery is fast. Therefore, in the early stages of the disease, the mother must pay close attention to the baby’s mental state, respiratory rate, temperature changes, diet and urine and stool. If your baby is depressed or restless, green around the mouth, shortness of breath, breath-holding or with a high fever that does not go away, you must go to a hospital in time to see a doctor.
2, if the baby has a cough with phlegm, the principle should be to reduce phlegm and stop the cough, never take strong cough suppressants in order to stop the cough. This will only treat the symptoms but not the root cause, masking the condition and making it worse. Especially the lung and cough Chinese medicine, premature application will make the phlegm more sticky, the condition worsens.
3, most colds are caused by viruses, if there is no co-infection, antibiotic treatment is ineffective. Therefore, do not take antibiotics for your baby at your own discretion. Abuse of antibiotics will only waste the drug and at the same time, it is easy to produce drug resistance or cause allergies. Antibiotics must be taken under the guidance of a doctor to be safe.
4, if the baby has a history of asthma, after the cold must pay attention to observe the breathing situation, found that there is an asthma attack timely application of asthma medication. Central cough suppressants such as codeine have a good cough suppressant effect, but long-term use is prone to addiction and dependence on the drug, and psychological and physiological symptoms such as irritability, nausea and vomiting will occur after stopping the drug, so its application is strictly controlled and needs to be purchased with a prescription. The cough suppressant that is widely used clinically is dextromethorphan, which is similar to codeine, has a rapid onset of action within 15-30 minutes, and is non-addictive within the effective dose, and is recommended by the World Health Organization as an alternative to codeine. When the human respiratory system is infected by pathogenic bacteria, the germs and sputum in the respiratory tract can be expelled from the body through coughing. If you have bronchitis or pneumonia, you will have a lot of phlegm in the upper and lower respiratory tract, so it is not advisable to use cough suppressants, otherwise you will stop coughing and leave the phlegm in the respiratory tract, spreading the inflammation.
6. Coughs that require urgent medical attention
1. If the child suddenly coughs severely and has difficulty breathing, a foreign body may be blocking the airway.
2. If the child coughs when exposed to pollen or other foreign substances, it is most likely to be asthma.
3.Shortness of breath and a persistent, hoarse cough after eating may be reflux esophagitis.
4. If a child has a violent and prolonged cough, it may be related to a specific disorder, the most serious being whooping cough. This cough is violent and hoarse, with each breath being taken several times in a row and accompanied by a sharp sound when inhaling hard.
5. High fever, coughing, wheezing and breathing difficulties require immediate emergency treatment at the hospital.
6. Infants are prone to capillary bronchitis, short, weak breathing when coughing, which is a form of pneumonia. The child’s face is not good, often purple, or breathing is faster, and the lower part of the chest wall is depressed during inhalation, so the child should also be sent to the hospital.
Seven, children with cough pay attention to “raising”
As the saying goes, “three parts cure, seven parts nourish”, so we must pay attention to “nourish” in order to cure pediatric cough.
1. Pay attention to indoor air circulation and avoid stimulating your child’s respiratory organs with smoke and dust.
2. If your child is sick, it is best not to take a bath. Because bathing will speed up blood circulation in the body, which will increase the production of throat secretions and make it easier to cause a cough.
3. Pay attention to keeping warm and try not to give your child sour, spicy, cold and other stimulating foods. Fresh vegetables such as green vegetables, carrots and tomatoes can supply a variety of vitamins and inorganic salts, which are beneficial to the recovery of the body’s metabolic functions.
4. The rapid airflow generated by coughing will take away the water on the respiratory mucosa and cause dehydration, so you should also pay attention to giving your child more water and fruit in the autumn and winter.
5. You should try to let your child rest in bed more often and ensure that he or she gets enough sleep to help his or her body recover.