Child has a violent, prolonged cough. Differential diagnosis of cough in children and its treatment

After a few days of illness, it should become damp. So that the child can quickly recover, it will be necessary to take drugs that soften cough and thinning phlegm. They should be recommended by a pediatrician. If the baby continues to cough for two weeks in a row, ask the doctor to prescribe massage, breathing exercises and physiotherapy.

Steam inhalation will also help to cope with a lingering cough. Use steamed leaves of plants such as eucalyptus, sage, linden, mint, as well as fir and pine needles. Good action for upper infections respiratory tract possesses thyme and coltsfoot.

Take 3 parts honey and 1 part horseradish juice, mix. Take in very small portions, three to four times a day, with an infusion of clover flowers. Prepare the infusion from 1 teaspoon of flowers per 200 ml of boiling water, leave for 1 hour, wrapping it well.

Crush 3 tablespoons of birch buds and mix with half a packet of butter. Put the mixture on fire, bring to a boil and simmer over the fire for an hour. Strain the mixture and squeeze the buds through cheesecloth. Boil 200 g of honey and add to the butter. Stir the medicine and take 1 tablespoon five times daily before meals.

Every mother wants her child to grow up healthy. The appearance of such alarming signs as coughing often indicates the presence of problems in the child's body. If a child's lingering cough does not go away for a long time, you should immediately consult a doctor and buy the drugs necessary for treatment.

The first and main rule of getting rid of a cough is to analyze the causes of its occurrence. Disruption of the cough center can be caused by airway inflammation, heart disease, and nervous system problems. The following reasons are distinguished that provoke a lingering cough.

Viral and infectious diseases. Such problems occur most often and are associated with the ingestion of bacteria or viruses. Among the diseases on this list are otitis media, sinusitis, whooping cough. To exclude their appearance and treat children correctly, consult a specialist.
Allergy. If the child's temperature is normal and there are no negative symptoms other than coughing, it is possible that we are talking about allergic reactions. In this case, you should often refresh the air in the apartment so that dust does not accumulate there.
Ingestion of foreign bodies in the respiratory tract. If the cough lasts several months and there is a suspicion of foreign body aspiration, a bronchoscopy and chest x-ray should be performed by a doctor.
The sensitivity of the corresponding receptors. During the rehabilitation period, sputum is usually secreted in large volumes. Bronchial hyperreactivity often manifests itself during sports, at night, in cold weather.
The impact of external factors from the surrounding world. So, smoke from cigarettes, pet hair, dust, an unpleasant smell can provoke a long one.
Gastroesophageal reflux. In the presence of this problem, constant chewing movements are often encountered even in the chest period. An examination by a gastroenterologist is necessary.
Psychogenic factors. According to statistics, 10% of the reasons for the appearance lingering cough associated in children with stress, depression and overwork. In this case, a dry metallic cough occurs with high regularity, disappearing during sleep, eating and conversations.

Dry cough treatment

You can get rid of a boring cough if you accurately determine its type. Doctors note that dry cough is characterized by viscous sputum in children, it is difficult to dilute it. It is necessary to treat the baby with drugs that will properly affect the cough center located in the medulla oblongata, and also reduce the sensitivity of the mucous membrane.

You can also use auxiliary natural medicines - for example, a mixture of lemon juice and honey. With a dry cough, many experts, including, for example, a doctor of the highest category, the well-known children's doctor Yevgeny Komarovsky, recommend ventilating the premises, humidifying the air, drinking a lot and walking more.

Wet cough treatment

Getting rid of this type of cough requires a phlegm-removing agent. As a rule, as part of complex treatment, mucolytic drugs are prescribed, as well as agents responsible for the normalization of bronchial secretion. The child should drink as much liquid as possible, do inhalations that will moisturize the mucous membrane. A wet cough will recede if you give the child infusions of herbs with an expectorant effect. They will relieve inflammation, and the bronchial mucosa will be less irritated.

Actions for a lingering cough

Whether your toddler's cough is wet or dry, take care of some simple treatments that will help bring welcome relief for kids.

Start giving your child steam inhalation. Eucalyptus, mint, pine, thyme, sage, coltsfoot, linden are excellent for this purpose. Steam the leaves and inhale with warm water. Do not perform this procedure only if you have a very young child, otherwise respiratory spasm may occur. Mixtures with nuts and figs help to restore the body's defenses. You can also eliminate phlegm when coughing thanks to inhalations with honey, but only if your children are not allergic to this product.
Coughing fits are relieved with massage movements. Do tapping, patting in the chest area, while adding a little pressure with your hands. In this way, you will help to remove phlegm from the walls.
If the body is low on water, the cough will take a long time to heal. For this reason, according to Dr. Yevgeny Komarovsky, children need to drink as much as possible. It's good if it is a warm liquid.
The drier the air in the apartment, the faster the phlegm dries up, which means, the more difficult it is to remove it from the body. Humidification of the air in the house will help to cope with this problem. To do this, you can place wet rags on the battery or keep dishes filled with water in the rooms.

Folk remedies

There are some helpful and simple tips on how to reduce the frequency of a lingering cough, no matter what the cause.

Rub your baby's breast with natural oils - eucalyptus or myrtle. This will allow him to sleep peacefully at night. If you take your baby to the bath, then add the same products to the steam room.
A mixture of onions, sugar and honey is good for coughing. It is necessary to fill the composition with water and heat it on the stove. Then cool, strain and send to the refrigerator. It should be consumed warm, in the dining room several times a day.
A warm night compress well relaxes and relieves from a lingering cough. It can be made from a mixture of honey and goat fat. It is necessary to rub the product into the skin, cover with compress paper and cover with a warm scarf made of wool or down.
A delicious and healthy cough mixture comes from hazelnuts and honey. The medicine should be taken in a teaspoon with milk several times a day.
Finally, you can treat a child's lingering cough with mashed banana mixed with boiled water and sugar. It should be taken warm.

Summing up

If your child is worried about coughing, it is difficult for him to sleep at night and attacks come more and more often, do not sit back, you need to treat him by following simple instructions.

Determine the cause of your cough. To do this, take your baby to the doctor for a number of necessary procedures.
Ventilate the apartment and humidify the air as often as possible.
Give your child massage and inhalation if he does not have allergic reactions and contraindications.
Children should be treated for coughs according to the type of cough (wet or dry).
Use folk advice if you are sure they are safe for your child's body.
Don't buy serious medications without a doctor's prescription. They may not only fail to bring the expected benefit, but also worsen the condition of the baby.

To be sure of a quick and painless release of a child from a boring lingering cough, do not forget to follow the simple recommendations from specialists:

Dr. Evgeny Komarovsky recommends paying attention to the mucus that comes off when you cough. It is thick or liquid and depends on the viscosity of the blood. To thin the blood, you should drink the child as often as possible.
It is recommended to set a humid and cool air level in the apartment to dilute the phlegm.
Remember that cough medicine consists mainly of two groups: expectorant mucolytics and whooping cough medicines that block seizures. Doctors do not recommend treating a lingering cough of children under 2 years of age with drugs that help sputum discharge.
If possible, do not use drugs with codeine, as they have a number of contraindications and are quite strong in their effect. Replace them with safer products.

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Cough is a symptom of many infectious diseasesand the common cold is just one of them. A prolonged cough in a child without a fever is an alarming sign that may mean the presence of a serious illness that has nothing to do with a banal ARVI. But a cough, accompanied by an increase in temperature, cannot be ignored.

Causes of a prolonged cough in a child

A long-term cough is considered one that does not go away for more than 3-4 weeks, but it is necessary to consult a doctor if the cough torments the child for more than a week. The cough can occur daily or intermittently. In any case, a persistent cough does not fit into the concept of a norm in any way and requires a doctor's consultation.

Many illnesses are accompanied by cough, including acute and chronic respiratory and pulmonary diseases, bronchial asthma, tuberculosis, neoplasms in the lungs, sarcoidosis, fibrosis, whooping cough, allergies, false croup (tracheal edema), measles, heart failure and reflux. Sometimes the cough is caused by mechanical irritation when inhaling caustic substances or drying out of the mucous membranes due to too dry air in the apartment.

For timely action, it is very important to learn to distinguish between dry and wet coughs in a child, since the mechanism of occurrence, causes, and methods of treatment for these two types of cough are different.

Dry cough (unproductive)

Tiring and annoying, often very violent and painful, but not accompanied by sputum production. A dry cough in a child is a characteristic sign of the initial stage of respiratory diseases, such as the flu. It also accompanies the development of whooping cough. Often, a sudden attack of dry cough is associated with the ingestion of a small object into the respiratory tract.

A prolonged dry cough that lasts for weeks without fever or weakness is often a sign of allergy. The most common culprits for this reaction are dust, pet hair, tobacco smoke, or car exhaust. The same effect can be caused by burning the respiratory tract with hot air or inhalation of caustic substances, as well as irritation by acidic gastric juice during reflux.

Wet cough (productive)

When wet cough sputum leaves, gurgling rales can be heard when breathing. During such a cough, the bronchi are cleared of fluid. A wet cough is characteristic of acute respiratory diseases (their onset is accompanied by a dry cough, but it quickly turns into a wet cough), pneumonia, and tuberculosis. It is important to pay attention to the color of the outgoing mucus:

if it is greenish, then the child may have pneumonia, cystic fibrosis, sinusitis or purulent bronchitis;
yellow sputum is a sign of purulent processes;
a rusty color indicates the presence of blood in the sputum, this is typical for pneumonia, in which small capillaries in the lungs can be damaged;
brown sputum is characteristic of such formidable diseases as lung cancer and tuberculosis;
thick white sputum is typical for ARVI, transparent - for asthma, allergies and heart disease.

Of course, a diagnosis cannot be made only on the basis of the color of mucus secreted when coughing, a doctor's consultation is necessary in any case.

How to cure a child's long dry cough

Of course, if a child suffers from a prolonged, excruciating dry cough, parents try to alleviate his condition. But not all cough suppressants that can be found in the pharmacy are suitable for this. Such funds are divided into two groups - some suppress the cough reflex, others thin phlegm and speed up its separation.

For the treatment of dry cough in a child, drugs from the first group are needed. Such funds include "Sinekod", "Ambrobene", "Eofinil" and some others. Many products of this type are based on herbal extracts and come in the form of syrup so that it is easier for children to take them.

Since coughing is only a symptom, treatment of the underlying disease must be started. With bacterial lesions, the doctor prescribes a course of antibiotics. It is very important not to interrupt antibiotic treatment even if symptoms have already disappeared. Antibiotics are prescribed by a doctor. For the right choice of the drug, laboratory tests are carried out and the pathogen is identified. The age of the child, the timing of the last course of antibiotic treatment, general health and much more are also taken into account.

A prolonged dry cough that occurs during the heating season is often associated with low humidity. Pediatricians advise purchasing a household humidifier and using it throughout the winter.

To relieve symptoms, inhalation can be performed using a nebulizer, a device that generates steam. Steam relieves spasms of the muscles of the respiratory tract and moisturizes the mucous membranes.

Treatment of prolonged wet cough in children

Means that suppress the cough reflex, so effective for dry cough, are strictly contraindicated when wet. Taking them will cause fluid to build up in the airways, causing severe inflammation. If the cough is productive, the body needs to be helped to remove mucus, and expectorant drugs are prescribed for this.

Expectorants for a wet cough in children thin the phlegm, and it is easily excreted. Such drugs are also often available in the form of sweet syrups, so that parents do not have to persuade their children to take the medicine. Expectorants include Lazolvan, Herbion, Doctor Mom, marshmallow syrup, mukaltin and many others. Often, such agents also have additional effects - anti-inflammatory, antimicrobial.

As with dry cough, steam inhalation with medicines, mineral water or essential oils.

Drinking plenty of fluids dilutes the phlegm with a wet cough and speeds up its separation. This applies to any liquid - from water and fruit drink to soup and milk.

Many folk methods treatment of wet cough in children is approved by modern medicine. This is especially true of treatment with decoctions of herbs. With a wet cough, decoctions of coltsfoot, sage, chamomile and linden blossom are effective.

We have described all these methods of treating dry and wet cough in children for general information only, and in no case do we advise parents to try to cure a child's cough on their own, without consulting a doctor. To accurately determine the cause of the cough and choose a treatment, you need to undergo laboratory and instrumental studies, in particular, a blood test and X-ray.

A cough in children is always a sign of concern. And in case if the symptoms do not go away within two weeks, then such a cough is called lingering... In many situations, a child's lingering cough can be triggered by bacterial infections of the respiratory tract, as well as allergic reactions or chronic lung diseases.

Parents should not ignore this, they should immediately take action. Get tested and start treatment. To identify the causes of a lingering cough in a baby, you need:

consult an ENT specialist, gastroenterologist, allergist;
take blood and urine tests;
perform x-ray chest;
in rare cases, additional analysis of feces is required.

A lingering cough in children is much more dangerous than in adults, due to the fact that the mucous membrane of the child is more vulnerable and more damaged by the cough. Therefore, during seizures, children may have hemoptysis.

By the nature of the manifestation, a lingering cough in children can be dry and wet.

Dry

The manifestation of a dry cough is observed with every colds (bronchitis, pharyngitis, tracheitis). As a result, the respiratory system becomes infected. During the course of a cold, inflammation in the pharynx and larynx, leads to sore throat and, accordingly, to a dry cough. The dry cough is usually severe and painful.

Wet

The formation of a wet cough is due to the accumulation of phlegm and mucus in the tracheobronchial tree and lungs. The phlegm contains bacteria and if they are not coughing up during the time, the infection spreads. Often wet cough preceded by dry. This cough helps to cleanse the lungs of phlegm. differs in a feeling of heaviness in the chest area, however, his attacks are not as painful as a dry cough.

Causes

When a baby's cough does not go away and lasts more than three weeks, then you should definitely find out the reasons for such manifestations. Because such a sign indicates the presence of anomalies in the child's body. You should not try to determine these reasons personally, entrust the life and health of the child to professional doctors.

With acute respiratory infections

A lingering cough in a child, resulting from acute respiratory disease, the most common type in children. It has the following characteristics:

duration for 2-3 days;
fever, runny nose, loss of appetite, restlessness;
a change in the nature of the cough (for example, dry becomes wet).

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No temperature rise

A lingering cough in children without fever is caused by the following reasons:

bronchial asthma;
inflammation of the ENT organs (pharynx or nose);
increased adenoid;
the onset of allergic processes;
a foreign object in the respiratory tract;
dry air in the house;
adverse effects of the surrounding atmosphere. The accumulation of negative substances that provoke a reflex: dust, wool, cigarette smoke
hypersensitivity of cough receptors;
gastroesophageal reflex (a disease in which food from the stomach returns to the esophagus, causing a cough)
psychogenic factors (stress, overwork, depression).

Most of the reasons are of a specific nature and additional studies are possible to establish the correct diagnosis.

Treatment

Establishing treatment for a lingering cough depends not only on the diagnosis, but also on other signs. The form of cough is of particular importance. During a dry cough, children have difficulties with the thickness of sputum, therefore, medications are prescribed that contribute to its thinning in the lungs. A wet cough is much, so it is recommended to take drugs that remove phlegm. With the exception of the form of cough, when prescribing a course, the doctor takes into account the patient's age, allergic reactions, individual intolerance and other signs.

Antibiotics

Before starting antibiotic treatment for a lingering cough in a child, you need to know the exact diagnosis. Antibiotic therapy is carried out, which reveals an infection that has appeared in the respiratory tract - sinusitis, otitis media, tonsillitis. Also, the doctor is obliged to check the baby for the presence of inflammatory processes in the lungs, pathology, and so on. A lingering cough also requires antibiotic treatment, but not in the initial stages. Taking antibiotics should be justified.

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Antibiotics should be chosen correctly. To do this, you need to see a doctor who has a card with diseases and pathogens. With the help of such a card, an antibiotic is selected that will help against the disease that worries the child. The doctor will prescribe a course of treatment. Choosing an antibiotic on your own can be detrimental to a child's health.

Expectorants and antitussives

When children have a dry, lingering cough, taking expectorant and antitussive drugs is necessaryas they thin phlegm. Children are treated with Glaucine, Butamirat, Tusuprex. It is also possible to use:

Libeksin, helps to reduce the susceptibility of the mucous membrane;
Delsima, relieves the symptoms of dry lingering cough for a long period;
Robitussin, prevents the appearance of cough.

Mucolytic drugs

Treatment in children of a lingering wet cough should promote sputum excretion. It is necessary to take mucolytic drugs. These drugs include: Ambroxol, Carbocisteine, Brombegsin.

Folk remedies

In order to cure a lingering cough, you need to know the reasons for its occurrence. If the cause is a cold, then you can cure it with folk remedies... For example, using black bread. It is necessary to crumble and knead it, then heat it up. Mix well with honey. Put the resulting mixture on a bandage and wrap the baby's back and chest.

Treatment with rubbing and compresses is a good way to overcome coughs. You need to melt the goat fat with honey. Rub the resulting solution into the skin and wrap in paper. Tie a scarf on top.

Potato compresses will help get rid of a lingering cough. Boil unpeeled potatoes, mash with a fork, add 3 drops of iodine and 1 tbsp. a spoonful of vegetable oil. Put the composition on a towel and put on the chest. It's good to wrap up the child. Remove the bandage when the potatoes are cold. Make a compress before bed.

It is useful to use radish in treatment. You need to take a small radish, make a niche in it, which is filled with juice. Add honey there. Let it brew for 12 hours. Give your baby one teaspoon 4 times a day.

An effective way to cure a cough is to inhale. It is recommended to use decoctions of thyme, coltsfoot, pine buds. Also a productive way of inhalation with honey, which leads to the disappearance of phlegm. The procedures should be carried out about 5 times a day.

Treatment is impossible without abundant drinking and massage. Let your baby drink more liquid: teas, decoctions, juices. A light massage helps to eliminate a child's lingering cough. During the massage, the child should be head down, tap and tap on the lungs. This will help remove phlegm from the walls of the respiratory system.

Be sure to read:

it is required to undergo an examination (pass tests);
consult a doctor to establish an accurate diagnosis;
treatment should be tailored to the type of cough (dry or wet);
antibiotics must be selected strictly for the pathogen bacterium and only as prescribed by a specialist.

If your child has obvious signs of a lingering cough, do not delay treatment, contact the clinic.

Cough is a protective mechanism for cleansing the bronchi and trachea. It occurs when exposed to "fast" or irritative receptors of mechanical and chemical stimuli and on "slow" C-receptors - inflammatory mediators. Rare cough tremors are physiological, they remove the accumulation of mucus from the larynx; healthy children "cough up" 10-15 times a day, more in the morning, which should not worry their parents.

In the differential diagnosis of cough, it is very important to distinguish between its temporal characteristics: acute cough; prolonged cough lasting three or more weeks after an acute episode; recurrent, arising periodically; prolonged persistent cough.

Types of cough

Acute cough ... It is characteristic of acute viral catarrh of the upper respiratory tract, as well as inflammation in the larynx (laryngitis, croup), trachea (tracheitis), bronchi (bronchitis) and lungs (pneumonia). If the airway tube is affected, cough at the beginning dry, unproductive - does not lead to sputum discharge and is subjectively felt as intrusive. With laryngitis and tracheitis, he often acquires barking character and metallic overtone. A dry cough accompanies a sore throat with laryngitis. With pneumonia, the cough is usually wet from the first hours of illness, it is often described as deep.

A wet cough is characteristic of an expanded picture of bronchitis, its tremors end in the discharge of sputum (in young children it is perceived by ear), arising again when it accumulates. Sputum discharge is subjectively perceived as relief.

In the differential diagnosis of an acute cough, it is important to make sure of its connection with the infection (fever, the presence of catarrhal syndrome). In a child with signs of an acute respiratory viral infection (ARVI), hoarseness, difficulty in breathing indicate a lesion of the larynx with a possible threat of asphyxia (croup). Moist wheezing in both lungs indicates bronchitis: in older children they are usually large and medium-bubbly, in small children they are often small-bubbly, which makes it possible to diagnose bronchiolitis.

The key task in the presence of signs of acute respiratory infections is to exclude pneumonia - most often, wheezing is absent in the lungs or is heard over a limited area of \u200b\u200bthe lung, where a shortening of the percussion sound and / or a change in the nature of breathing is also determined. The nature and strength of the cough does not indicate the etiology of pneumonia. The exception is stokato cough with chlamydial pneumonia in children of the first months of life: "dry", abrupt, sonorous, followed by attacks, but without reprises, accompanied by tachypnea, but not a febrile reaction.

Spasmodic cough characteristic of bronchial asthma, and in children of the first years of life - with acute obstructive bronchitis or bronchiolitis. In these forms, wheezing is accompanied by lengthening of exhalation, which indicates the presence of bronchial obstruction. A spasmodic cough is usually unproductive, obsessive, and often has a sibilant overtone at the end.

In case of sudden onset of cough, including spastic cough, without signs of ARVI, you should also think about a foreign body in the respiratory tract, especially in a child who has not previously had a spastic cough. He is characterized by an attack whooping cough - intrusive, but not accompanied by reprises. Such a cough can last for a short time; when a foreign body moves into the smaller bronchi, the cough can stop. A foreign body is often accompanied by swelling of one lung, over which a weakening of breathing and, often, a wheezing exhalation is heard; with such symptoms, bronchoscopy is indicated.

Lingering cough (more than 2 weeks). It is observed quite often, usually after acute bronchitis. Most often it is associated not so much with inflammatory process as such, how much with post-infectious hyperproduction of sputum and, often, with hypersensitivity of cough receptors. In decoding such a cough, it is important to take into account the child's age.

In infants after obstructive bronchitis, the persistence of mucus hypersecretion with an increase in the cough threshold causes a rare wet cough for 4 weeks or more; its distinctive feature is the presence of "hoarseness" - bubbling sounds in the chest, heard at a distance, which disappear after coughing and reappear as sputum accumulates. Sputum from the trachea and larynx in infants is evacuated by more rare cough shocks, when the lumen of the bronchi is almost completely blocked. In such children, coughing with pressure on the trachea (or with a spatula on the root of the tongue) is difficult to cause. The cough associated with hypersecretion gradually subsides - both in frequency and in intensity.

In this case, however, cough associated with habitual aspiration of food due to dysphagia should be excluded - the most common reason lingering cough in infants, both breastfed and artificially fed. Establishing the fact of dysphagia usually requires monitoring the feeding process, since not every mother fixes attention on the connection between coughing and food intake. In addition to "choking", "coughing" while eating, aspiration of food is characterized by the appearance of wheezing, which quickly disappear or change their localization and intensity after a cough shock. Chest x-rays in these children usually show a darkening or increased pulmonary pattern in the upper lobes.

Cough when eating is also observed in the presence of a bronchoesophageal fistula; its distinctive feature is the separation of copious foamy sputum; the presence of this symptom requires a contrast study of the esophagus and esophagoscopy.

For children with, in addition to dysphagia, gastroesophageal reflux, coughing fits during sleep are characteristic. The detection of a wet pillow confirms this diagnosis.

Prolonged cough in children of early and preschool age is often caused by the flow of mucus into the larynx from the nasopharynx with long-term nasopharyngitis, adenoiditis, adenoid hypertrophy; unlike cough in bronchitis, it is not accompanied by wheezing in the lungs, often has a superficial character and disappears during the treatment of the process in the nasopharynx. A prolonged episode of bronchitis with coughing for 2-4 weeks is common in preschoolers with recurrent bronchitis.

Lingering dry cough in schoolchildren and adolescents, which can last up to 6 weeks, often with tracheitis or tracheobronchitis, developing with some respiratory viral infections (RS, rhinos, parainfluenza viruses). It is often painful, paroxysmal, the attack ends with a lump of dense mucus (fibrinous overlays). Special studies, however, have shown that among children of this age coughing for more than 2 weeks, 25% or more tolerate whooping cough in their characteristic atypical form - without pronounced paroxysms and reprises.

This course of whooping cough is typical for both incompletely vaccinated children and children who received 3 vaccinations and revaccination at 18 months. The fact is that pertussis immunity gradually fades away and after 5-6 years - by school age - most of the vaccinated become susceptible to this infection. Its atypical course contributes to late diagnosis (if at all) and the spread of infection and infection of infants who have not yet fully received all vaccinations.

A lingering cough in adolescents with whooping cough is characterized by the absence of wheezing in the lungs, it usually does not intensify and does not acquire a specific character, as in the unvaccinated. Sometimes, however, it is possible to press with fingers on the trachea or with a spatula on the root of the tongue to cause a semblance of a whooping cough thrust with protruding tongue, redness of the face, less often with a typical reprise. Bacteriological diagnosis of whooping cough in these children is rarely possible; it is more reliable to determine in the blood of antitoxic antibodies, which are present in high titers in the diseased, in contrast to the vaccinated.

Recurrent cough ... It is characteristic, first of all, for patients with bronchial asthma - this is one of the frequent complaints of parents of children whose asthma diagnosis has not yet been established. The cough that accompanies almost every episode of acute respiratory viral infections is also characteristic of recurrent bronchitis - it is usually moist, protracted, its duration exceeds 2 weeks, it is not accompanied by obvious signs of bronchospasm, which, however, is often detected during the study of function external respiration (FVD) (test with bronchodilators).

With recurrent obstructive bronchitis (ROB) in children under 3-4 years of age, cough - wet or "spastic" - occurs against the background of ARVI, usually in the presence of fever and catarrhal syndrome. Unlike cough in bronchial asthma, it does not have the character of an attack. However, by the type of cough, these two forms can hardly be distinguished, since cough and obstruction against the background of ARVI are the most common type of exacerbation and bronchial asthma, especially in young children. For many of them, the diagnosis of RBD over time "spills over" into the diagnosis of asthma, if such episodes are repeated more than 3-4 times or if periods of coughing are not associated with exposure to ARVI, but an allergen, exercise, cold air, or appear as if for no apparent reason - as a result of increased inflammatory changes in the bronchial mucosa.

Prolonged, persistent cough ... It is observed in chronic diseases of the respiratory system, which immediately distinguishes it from the types of cough described above. Of course, it can intensify or weaken in certain periods of time, but it is fundamentally important that the child almost constantly coughs.

Moist persistent cough observed in most suppurative lung diseases, accompanied by the accumulation of sputum. Often, the cough is especially strong in the morning; after sputum separation, it becomes less frequent. A deeper cough by ear is typical of bronchiectasis; in case of bronchial cartilage defects (Williams-Campbell syndrome), it can have spastic overtones.

With cystic fibrosis, the cough is often obsessive and painful due to the viscosity of the sputum, often accompanied by signs of obstruction. The diagnosis is not difficult in the presence of other manifestations of cystic fibrosis - weight loss, polyfecal matter, drumsticks, etc., however, there are milder forms of this disease, so the study of sweat electrolytes is indicated in all children with persistent cough.

Persistent dry cough with a change in voice may indicate papillomatosis of the larynx. Dry cough accompanied by shortness of breath, chest deformity, signs pulmonary heart, drumsticks are characteristic of fibrosing alveolitis.

Deserves special attention psychogenic cough , for which a persistent cough is also typical. This is usually a dry, metallic-tinged cough that occurs only in the daytime and disappears during sleep, its distinctive feature is regularity and high frequency (up to 4-8 times per minute), cessation during eating and talking. A psychogenic cough usually occurs as a reaction to stressful situations in the family and at school, then becomes habitual, it often begins during acute respiratory infections, acquiring the character described above rather quickly. In some children, such a cough has the character of a tic or a manifestation of obsessive-compulsive disorder (Gilles de la Tourette's syndrome).

Young children often cough when stressed - usually to achieve their goals; the cough intensifies before and during the examination by the doctor, stopping at the end of it (relieving the "stress of waiting"). A new attack of coughing can be provoked by touching on a topic unpleasant for the child (whims, adherence to the daily routine) or even simply starting an abstract conversation, not paying attention to the child. The reason for the consolidation of the cough reflex in a child may be the increased anxiety of the parents, their concentration on respiratory symptoms. Such children require in-depth examination to exclude organic pathology, sometimes trial treatment with antispasmodics and steroid aerosols.

Some types of coughs differ in nature.

Bitonal cough (low, then high tones). It occurs with tuberculous granulations from a lymphobronchial fistula, sometimes with foreign bodies large bronchi. It is an indication for bronchoscopy.

Cough when inhaling deeply ... Pain is accompanied by pleural irritation; it goes away after anesthesia (codeine, Promedol). The same cough during restrictive processes is associated with an increase in lung rigidity (allergic alveolitis). A deep breath also causes a cough in children with asthma - it occurs as a result of bronchial hyperreactivity; Shallow breathing is an integral part of a number of exercise therapy (exercise therapy) systems used to treat asthma.

Night cough ... Typical for bronchial asthma, it usually occurs closer to the morning due to increased bronchospasm; he often indicates an allergy to the feather in the pillow. A number of children night cough is the equivalent of asthma and should be evaluated accordingly. Nocturnal cough is also observed with gastroesophageal reflux, while older children complain of heartburn. Quite often, a nocturnal cough occurs in children with sinusitis or adenoiditis due to mucus entering the larynx and drying the mucous membrane when breathing through the mouth.

Exercise cough - a sign of bronchial hyperreactivity, observed in a significant part of patients with bronchial asthma.

Cough with syncope - short-term loss of consciousness - occurs due to a decrease in venous inflow with an increase in intrathoracic pressure and, as a result, a decrease in cardiac output; the condition is benign, except for antitussives, treatment does not require.

Cough treatment

The fight against cough has been waged by humanity since time immemorial - even now, when we know so much about coughing, both parents and many pediatricians regard cough as an unwanted symptom and strive to stop it. Complaints about coughing and persistent requests from parents to treat coughs are apparently connected not only with the fact that coughing is a clear sign of a child's ill health. Subjectively, the cough of a person who is nearby or in close surroundings is perceived as an annoying, unnerving phenomenon. Hence the desire to stop coughing at all costs.

What new does the modern understanding of the nature of cough give us? First, that there are several reasons for cough and that it makes sense to suppress only cough caused by "dry" inflammation of the respiratory tract mucosa - for example, with laryngitis, as well as cough associated with pleural irritation. In those cases where the cough leads to the removal of sputum, suppressing it is impractical and even dangerous. It is important to educate parents that coughing is a defensive response aimed at clearing the airways in the face of mucus hypersecretion and reduced mucociliary clearance. In practice, the treatment of cough as such is required only in rare cases when it significantly disrupts the patient's life.

Antibiotics ... First of all, it is important to understand that the presence of a cough in itself is not a reason for antibiotic therapy. It is carried out only with proven bacterial infection of the upper respiratory tract (otitis media, sinusitis, streptococcal sore throat) and lung damage (pneumonia, including chronic pneumonia, cystic fibrosis, lung malformations). With regard to acute bronchitis, it has been proven that antibacterial therapy is justified only with mycoplasma and chlamydial etiology (10-15% of the total number of bronchitis, more often at school age), while the bulk of bronchitis, including obstructive ones, are viral diseases.

Antibacterial treatment of whooping cough, including that proceeding in the form of a prolonged cough at an early onset (in the first 7-10 days) can interrupt clinical manifestations... In more late dates It is difficult to expect a large effect from antibiotics, however, such treatment stops bacilli excretion within 2-3 days, so it is fully justified from an epidemiological point of view. Erythromycin (50 mg / kg / day) and clarithromycin (15 mg / kg / day) for 10-14 days or azithromycin (10 mg / kg / day) for 5 days have proven efficacy.

Published in the literature, primarily by otolaryngologists, data on the use of the local antibiotic fusafungin (Bioparox) after tonsillo- and adenotomy operations, as well as in adenoiditis, ARVI. The drug also has a local anti-inflammatory effect. Taking into account the fact that with ARVI there is a multiplication of pneumococci and Haemophilus influenzae, its use in children at risk may be justified. However, in case of proven bacterial infections (streptococcal sore throat, otitis media, etc.) Bioparox does not replace systemic antibiotics.

Laryngitis treatment ... With a barking cough accompanying laryngitis, it is customary to inhale with hot steam - for example, in a bathroom with an open hot water tap. However, it has been proven that this type of treatment is ineffective for both croup and bronchitis. A meta-analysis of numerous studies on the treatment of croup has shown that the most effective prevention of the development (or progression) of stenosis of the larynx is in / m administration of dexamethasone (0.6 mg / kg) or, in milder cases, inhalation of budesonide (Pulmicort). These funds also contribute to the rapid cessation of coughing.

Antitussives and expectorants ... A dry cough is theoretically an indication for the appointment of antitussives, but in most cases of acute respiratory viral infections it is replaced by a wet one after a few hours, in which these drugs are contraindicated. As antitussives in children, mainly non-narcotic drugs are used - butamirate, dextromethorphan, glaucine, oxeladine, pentoxiverine (Table 1). In a recent study, it was shown, however, that a spoonful of buckwheat honey at night soothes nocturnal cough in children 2-18 years old with ARVI, at least not worse than a dose of dextromethorphan. And milk with lye, tea with jam, etc. "home" remedies soothe barking cough with pharyngitis (sore throat) no worse than "antiseptic" lozenges or sprays. This has led the WHO to recommend only home remedies for coughs.

In cases where you have to appoint medicines from pharyngitis, given that most of the products contain antiseptics that violate the biocenosis of the oral cavity, it is preferable to use inhalations of Bioparox, a bacteriostatic that also has anti-inflammatory effects.

With a wet cough, suppression of cough is unacceptable, so intervention is justified only if the evacuation of sputum is difficult. The effectiveness of expectorants (mainly of plant origin) is highly questioned; in addition, their use in young children may be accompanied by an allergic reaction and vomiting. Nevertheless, these drugs (preparations of mint, marshmallow, licorice, oregano, coltsfoot, anise, wild rosemary, thyme, etc.) are widely used, which can be justified by their cheapness and safety (Table 2). But the use of expensive forms of such funds, even if they contain extracts of exotic plants (Greenland herbs, quebracho, ivy leaves), cannot be justified. Rubbing the chest with drugs containing essential oils (eucalyptus, pine needles, etc.) and balms that are absorbed by the skin are no more effective than expectorants.

On sale there are combined agents containing both expectorants and antitussives (Bronholitin, Tussin, etc.) (Table 1). The idea behind them is to make coughs less frequent but more productive, which should soothe parents. These combinations also have no proven efficacy in children, but their testing in adult patients showed that such combinations do not improve sputum discharge, but significantly reduce the FVD. After that, it is unlikely that these funds can be seriously recommended in practice.

Mucolytics ... The use of mucolytics is more justified, especially when chronic diseasesaccompanied by an abundance of viscous sputum (cystic fibrosis, chronic pneumonia, bronchial malformations). The most pronounced mucolytic effect in N-acetylcysteine, which is used in pediatric practice, mainly for cystic fibrosis and chronic pulmonary suppuration. However, it is difficult to attribute it to indispensable drugs: for example, in the United States, acetylcysteine \u200b\u200bis used relatively rarely in patients with cystic fibrosis, giving preference to vibratory massage. In the presence of purulent sputum in patients with cystic fibrosis, Pulmozyme (dornase-alpha) is shown, which cleaves the DNA that accumulates in the sputum during the decay of cellular elements (Table 3). The use of these agents is permissible only in conditions where postural drainage can be carried out after their introduction.

Use acetylcysteine \u200b\u200bwhen acute diseases, including bronchitis, should not be, because viscous sputum is rare with them, and there is no possibility of postural drainage in case of "waterlogging" of the lung with liquid sputum, and this drug is allowed from the age of 12.

In acute and recurrent bronchitis, improvement of mucociliary transport is better achieved with the help of carbocysteine \u200b\u200band ambroxol, the latter can be used both orally and in the form of an aerosol - in children receiving inhalation of sympathomimetic for obstructive bronchitis.

Suppression of cough accompanying obstructive syndrome is also not an end in itself - the use of sympathomimetics, eliminating bronchospasm, and contribute to the cessation of cough (Table 4). In status asthmaticus, accompanied by the formation of bronchial casts, attempts to use N-acetylcysteine \u200b\u200bcan lead to increased bronchospasm.

Anti-inflammatory drugs ... The use of topically acting inhaled corticosteroids (ICS) forms the basis of therapy for moderate and severe bronchial asthma. Both metered-dose inhalers (beclomethasone, budesonide, fluticasone) and solutions for a nebulizer with budesonide (Pulmicort) are used, especially in children under 3-5 years of age (Table 5). By suppressing inflammation in the bronchial mucosa, ICS helps to stop the cough it causes.

ICS can also be used for respiratory infections of a more severe course, in which cough is associated, first of all, with an inflammatory process in the bronchial mucosa. In particular, the use of these agents in the convulsive period of whooping cough reduces the frequency and intensity of coughing attacks. ICS (together with sympathomimetics) can be used in the treatment of obstructive bronchitis (especially recurrent RBP) in young children. And although ICS does not shorten the duration of the disease, they have a positive effect on the severity of the acute period; there is also evidence of a decrease in the frequency of relapse of obstruction with continued treatment with ICS for 2-4 weeks after the end of the acute period. With prolonged cough due to tracheitis, ICS also often bring lasting relief.

The use of ICS, for obvious reasons, cannot be a “cough suppressant” for most respiratory infections... An alternative to them is the non-steroidal anti-inflammatory drug fenspiride (Erespal - syrup 2 mg / ml), which, as a rule, does not have serious side effect... This drug improves mucociliary clearance, has activity as an antispasmodic and blocker of H1-histamine receptors. In many patients, especially with recurrent bronchitis, including obstructive, chronic pathology, Erespal (at a dose of 4 mg / kg / day, in children over 1 year old - 2-4 tablespoons per day) brings clear relief of cough and condition generally.

Treatment of psychogenic cough ... Children with psychogenic cough are usually not helped by antitussives, expectorants, muco- and antispasmodics. Their treatment (after excluding a possible organic cause of cough) usually requires the appointment of neuroleptics, hypnotherapy and is carried out in conjunction with neuropsychiatric specialists. In the presence of disorders of the compulsive-obsessive type, there is experience with the use of slowly increasing doses of Clonidine. Treatment usually requires a considerable time (many months), although in some cases the cough may suddenly disappear and begin again (in some cases in the form of compulsive sneezing).

V. K. Tatochenko, Doctor of Medical Sciences, Professor
SCCH RAMS, Moscow