Recurrent coughing in babies is a major problem that makes parents uncomfortable. Professor Jiang Yi, director of the Department of Pediatrics II at Wuhan University People’s Hospital, points out that chronic cough in children is defined as a cough lasting longer than 4 weeks and has four main culprits.
1. upper airway cough syndrome Various rhinitis (allergic and non-allergic), sinusitis, chronic pharyngitis, chronic tonsillitis, nasal polyps, adenoid hypertrophy and other upper airway diseases can cause chronic cough, which was previously diagnosed as postnasal drip (flow) syndrome, meaning cough caused by nasal secretions flowing backwards through the postnasal orifice toward the pharynx. The main manifestations of the disease are.
(1) chronic cough with or without coughing sputum, which is worse in the early morning or when the position is changed, often accompanied by nasal congestion, runny nose, dry throat with foreign body sensation, repeated clearing of the throat, feeling of mucus adherence to the posterior pharyngeal wall, and in a few children, headache, dizziness, and low-grade fever.
(2) Examination of the sinus area may have pressure pain, there may be yellowish-white discharge from the sinus opening, the posterior pharyngeal wall follicles are obviously hyperplastic and cobblestone-like, and sometimes mucus-like attachment to the posterior pharyngeal wall is seen.
(3) Targeted treatment such as antihistamines and leukotriene receptor antagonists, and nasal glucocorticoids are effective.
(4) sinusitis caused by the sinuses, sinus x-ray plain or CT film can be seen corresponding changes.
2, cough variant asthma it is one of the common causes of chronic cough in children, especially in preschool and school-age children. Its main manifestations are.
(1) persistent cough >4 weeks, often with episodes at night and/or early in the morning, aggravated by exercise, exposure to cold air, and no clinical signs of infection or ineffective after longer antibiotic treatment.
(2) Diagnostic treatment with bronchodilators results in significant relief of cough symptoms.
(3) Normal pulmonary ventilation with bronchial excitation tests suggesting airway hyperresponsiveness.
(4) A history of allergic disease including drug allergy, and a positive family history of allergic disease. Positive allergen testing may aid in the diagnosis.
(5) Chronic cough caused by other diseases.
3. Gastroesophageal reflux cough Gastroesophageal reflux is a physiological phenomenon in infancy and early childhood. It occurs in 40-65% of healthy infants, peaks at 1-4 months, and mostly resolves spontaneously at 1 year of age. It becomes a disease when it causes symptoms and/or is accompanied by gastroesophageal dysfunction, i.e., GERD. The prevalence of the disease in children is about 15%. Its main manifestations are.
(1) paroxysmal cough, sometimes severe, occurring mostly at night.
(2) Symptoms mostly appear after eating and drinking, and feeding is difficult. (2) Some children have epigastric or subxiphoid discomfort, retrosternal burning sensation, chest pain, and sore throat.
(3) Infants may suffer from asphyxia, bradycardia and an arched back, in addition to causing a cough.
(4) It can lead to stagnant or delayed growth of the affected child.
4. Eosinophilic bronchitis A recent prospective study revealed that eosinophilic bronchitis accounts for 13.5% of chronic cough patients in adults. The main manifestations are.
(1) chronic irritant cough.
(2) Normal chest x-ray.
(3) Normal pulmonary ventilation without airway hyperresponsiveness.
(4) Relative percentage of eosinophils in sputum > 3%.
(5) Effective treatment with oral or inhaled glucocorticoids.
In addition to the four main culprits, there are other causes of chronic cough, such as tuberculosis and pertussis-like cough. Therefore, it is crucial to clarify the cause of chronic cough. It is recommended that children with chronic coughs that persist for a long time should go to a pediatric respiratory specialist at a hospital for a systematic diagnosis and examination to try to identify the cause so that targeted treatment can be given to relieve the chronic cough as soon as possible.