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What is chronic cough in children?  [PDF]
Iulia Ioan,Mathias Poussel,Jana Plevkova,Ivan Poliacek,Donald C. Bolser,Paul W. Davenport,Milos Tatar,Fran?ois Marchal,Cyril Schweitzer,Giovanni Fontana,Silvia Varechova
Frontiers in Physiology , 2014, DOI: 10.3389/fphys.2014.00322
Abstract: The cough reflex is modulated throughout growth and development. Cough—but not expiration reflex—appears to be absent at birth, but increases with maturation. Thus, acute cough is the most frequent respiratory symptom during the first few years of life. Later on, the pubertal development seems to play a significant role in changing of the cough threshold during childhood and adolescence resulting in sex-related differences in cough reflex sensitivity in adulthood. Asthma is the major cause of chronic cough in children. Prolonged acute cough is usually related to the long-lasting effects of a previous viral airway infection or to the particular entity called protracted bacterial bronchitis. Cough pointers and type may orient toward specific etiologies, such as barking cough in croup or tracheomalacia, paroxystic whooping cough in Pertussis. Cough is productive in protracted bacterial bronchitis, sinusitis or bronchiectasis. Cough is usually associated with wheeze or dyspnea on exertion in asthma; however, it may be the sole symptom in cough variant asthma. Thus, pediatric cough has particularities differentiating it from adult cough, so the approach and management should be developmentally specific.
Achalasia: unusual cause of chronic cough in children
Nighat F Mehdi, Miles M Weinberger, Mutasim N Abu-Hasan
Cough , 2008, DOI: 10.1186/1745-9974-4-6
Abstract: Achalasia is a disorder of esophageal motility which occurs rarely in children [1]. Achalasia is caused by loss of inhibitory enervation of lower esophageal sphincter and is characterized by failure of the sphincter to relax. This failure of relaxation causes poor emptying of the esophagus and subsequent dilatation and abnormal contractility of the proximal esophagus. The most commonly presenting symptoms of achalasia include dysphagia, chest pain, vomiting, belching, regurgitation of undigested food and failure to thrive. Cough can occur in achalasia primarily due to aspiration of the undigested food particles or airway compression from dilated esophagus[2].Due to its rare occurrence, achalasia is not commonly thought of in evaluating children with chronic cough and diagnosis can be consequently delayed. We report two cases of achalasia in children presenting primarily with chronic cough.A 9-your old girl presented for evaluation of 18 month history of nocturnal cough and post-tussive emesis. Cough occurred mainly at nighttime, occasionally triggered by exercise and was almost always followed with non-bilious vomiting of semi-digested food. Several courses of antibiotics had been given with no improvement in symptoms. Codeine containing cough suppressants were only temporarily effective. There was no response to albuterol inhaler, oral antihistamines and nasal steroids. Besides cough and post-tussive emesis, patient's parents also described less bothersome symptoms of nausea, gagging and epigastric pain. Past medical history was remarkable for being diagnosed with pneumonia a year ago and with bronchiolitis in infancy.On examination, she was above the 25th percentile for weight and above the 75th percentile for height. Vital signs were normal. Chest exam showed no signs of respiratory distress and was clear to auscultation. Initial evaluation showed normal chest x-ray, normal lung spirometry, normal exercise challenge, and negative skin testing to common inhaled al
Sinusitis in Children  [cached]
Ali Bülent Cengiz
Cocuk Enfeksiyon Dergisi , 2009,
Abstract: Sinusitis is a common disease among children. Acute bacterial sinusitis usually develops after viral upper respiratory tract infection. Acute bacterial sinusitis diagnosis in children is generally based on clinical criteria (the situation whereby the findings and symptoms of upper respiratory tract infection are more severe or last longer than expected in a viral upper respiratory tract infection). Because the treatment of acute bacterial sinusitis requires the use of antibiotics, correct diagnosis is crucial. This article reviews sinusitis pathogenesis, classification of sinusitis, the pathogens that cause sinusitis among children –primarily including acute bacterial sinusitis-, clinical findings of sinusitis and current knowledge about the diagnosis and treatment of sinusitis.
Can a management pathway for chronic cough in children improve clinical outcomes: protocol for a multicentre evaluation
AB Chang, CF Robertson, PP van Asperen, NJ Glasgow, IB Masters, CM Mellis, LI Landau, L Teoh, PS Morris
Trials , 2010, DOI: 10.1186/1745-6215-11-103
Abstract: We are conducting a multicentre randomised controlled trial based in respiratory clinics in 5 major Australian cities. Children (n = 250) fulfilling inclusion criteria (new patients with chronic cough) are randomised (allocation concealed) to the standardised clinical management pathway (specialist starts clinical pathway within 2 weeks) or usual care (existing care until review by specialist at 6 weeks). Cough diary, cough-specific quality of life (QOL) and generic QOL are collected at baseline and at 6, 10, 14, 26, and 52 weeks. Children are followed-up for 6 months after diagnosis and cough resolution (with at least monthly contact from study nurses). A random sample from each site will be independently examined to determine adherence to the pathway. Primary outcomes are group differences in QOL and proportion of children that are cough free at week 6.The clinical management pathway is based on data from Cochrane Reviews combined with collective clinical experience (250 doctor years). This study will provide additional evidence on the optimal management of chronic cough in children.ACTRN12607000526471Cough is the most common symptom presenting to primary care in Australia and internationally [1,2]. It is one of the most common reasons for referral to respiratory physicians. The burden of the symptom is considerable- both in terms of personal cost (e.g. impaired quality of life and multiple doctor consultations)[3] and at a societal level (through absences from school and work[4,5] and substantial medication expenses) [6]. Our previous studies have shown that >80% of parents of children with chronic cough have sought ≥5 medical consultations prior to referral [3]. Furthermore, ignoring cough (which may be the sole presenting symptom of an underlying respiratory illness) could lead to progression of a serious illness (such as bronchiectasis or retained foreign body in the airways) [7,8]. Paradoxically, cough is poorly researched. Patients are often inappropriately
Chronic Cough in Otorhinolaryngologic Routine  [cached]
Palheta Neto, Francisco Xavier,Ramos, Camilo Ferreira,Silva, Amanda Monteiro Tavares e,Santos, Karla Araújo Nascimento dos
International Archives of Otorhinolaryngology , 2011,
Abstract: Introduction: The chronic cough is sometimes manifested as an imprecise symptom, but of great importance for both the diagnosis and the prognosis. In an otorhinolaryngologic approach, several illnesses that can occur with it can be numbered, including 2 of the 3 main causes of chronic cough. Objective: To identify the main otorhinolaryngologic diseases showing the chronic cough as one of their manifestations. Method: A literature's revision was performed in several scientific articles, specialized books and consultation in Birene and Scielo databases. Literature's revision: cough production in the upper airways is usually associated with an inflammatory reaction by stimulating sensitive receptors of these areas or by mechanic stimulus. The main cause of the chronic cough in the otorhinolaryngology day-to-day is the post-nasal drip, gathering together by itself 02 of the most common diseases: rhinitis and sinusitis. Laryngitis as a result of gastroesophageal reflux (GER) stands out in the index of chronic cough etiology, but it is not as severe as GER . Neoplasias are also somewhat frequent causes of cough, and the difficulty in diagnosing the cough cause is common in this disease group. Motility disorder, laryngeal irritation persistence, parasitic disease and injuries by inhalation of toxic products were also found as a cause of cough for longer than 03 months. Conclusion:Chronic cough is a frequent and important finding in otorhinolaryngology and cannot be underestimated, and a careful anamnesis is the best way to determine the etiology and perform a correct treatment for the patient's disease.
Chronic productive cough in school children: prevalence and associations with asthma and environmental tobacco smoke exposure
Edward R Carter, Jason S Debley, Gregory R Redding
Cough , 2006, DOI: 10.1186/1745-9974-2-11
Abstract: We performed a cross sectional survey of 2397 Seattle middle school students, 11–15 years old, using written and video respiratory-symptom questionnaires. We defined CPC as – daily cough productive of phlegm for at least 3 months out of the year; current asthma as – yes to "Have you had wheezing or whistling in your chest in the past 12 months?" and yes in the past year to any of the four video wheezing/asthma video scenarios; and ETS exposure as exposed to tobacco smoke at least several hours each day. We used multilogistic regression to examine relationships between CPC, asthma, and ETS exposure and included in the model the potentially confounding variables race, gender, and allergic rhinitis.The prevalence of CPC was 7.2%. Forty-seven percent (82/173) of children with CPC met criteria for current asthma, while only 10% (214/2224) of those without CPC had current asthma. Current asthma had the strongest associated with CPC, odds ratio (OR) 6.4 [95% CI 4.5–9.0], and ETS was independently associated with both CPC, OR 2.7 [1.8–4.1] and asthma, OR 2.7 [1.5–4.7].In a population of young teenagers, CPC was strongly associated with report of current asthma symptoms and also with ETS exposure. This suggests that asthma and ETS exposure may contribute to CPC in children. However, this study was not designed to determine whether asthma was the actual cause of CPC in this population of children.Asthma is a recognized cause of persistent cough in both adults [1,2] children [3], but cough productive of sputum for more than three months out of the year, referred to as chronic productive cough (CPC), is not considered common in children with asthma. The NHLBI guidelines do not discuss productive cough as a separate sign [4], and little is known about the prevalence of CPC and its causes in children.Chronic productive cough is a hallmark of the rare conditions cystic fibrosis, ciliary dysmotility, and bronchiectasis, but it is possible that asthma and ETS exposure lead to CPC as
Muhammad Fahim Malik
The Professional Medical Journal , 2001,
Abstract: OBJECTIVES: To evaluate the results of antibiotic plus mucolytic agent and the antibiotic alonein the treatment of chronic sinusitis. DESIGN: Retrospective study. SETTING: ENTDepartment Jinnah Hospital/AIMC Lahore and ENT Department B.V. Hospital/QAMCBahawalpur. PERIOD: 1998 to 1999. MATERIAL & METHODS: The study was conductedin 100 patients and symptomatic relief of nasal obstruction, rhinorrhoea, post-nasal drip and intermittentfacial pain was studied. RESULTS: Symptomatic relief in chronic sinusitis was much better whereantibiotic plus mucolytic agent were used in comparison to the cases where antibiotics were used alone.CONCLUSION: Mucolytic agents liquify the thick secretions in chronic sinusitis hence allow betterpenetration of antibiotics to the site of infection in the sinuses moreover allow better ciliary functions.
A rare cause of specific cough in a child: the importance of following-up children with chronic cough
Richard Barr, David McCrystal, Christopher Perry, Anne B Chang
Cough , 2005, DOI: 10.1186/1745-9974-1-8
Abstract: An 8-year-old girl from a remote Aboriginal community approximately 2500 km from Brisbane was transferred to our hospital for management of a bronchial lesion. She had received 7-days of intravenous amoxicillin prior to transfer. She had a 4-year history of daily wet and sometimes productive cough, which was worse on exertion. There was no history of exertional dyspnoea, haemoptysis or weight loss. She also had a history of recurrent admissions for pneumonia at the local hospital (3 in the past 6 months). In the child's community, two adults were recently diagnosed with active pulmonary tuberculosis.On arrival, the child was thin (weight 5th percentile, height 25th), appeared well and had a wet cough, reduced air entry over the right side and inspiratory crepitations. Spirometry values were invalid as she could not adequately perform maximum expiratory manoeuvres. Chest x-ray (CXR) showed right upper lobe (RUL) collapse, tram-tracks signs and increased peribronchial and interstitial markings of the right lower lobe. These CXR changes were documented at least 4-months ago (figures 1 and 2). Chest high resolution computerised tomography (CT) scan revealed RUL collapse and severe cystic bronchiectasis and cylindrical bronchiectasis of the right middle and lower lobes (figures 3 and 4). Sputum cultures grew Moraxella catarrhalis, and the microscopy was negative for acid-fast bacilli. Mantoux tests (M. tuberculum, M. Avium) were negative, sweat test and immunological workup were normal. Flexible bronchoscopy revealed a large lesion at the carina (Figure 5). Rigid bronchoscopy was then immediately performed during which the lesion was only partially removed piecemeal because of the presumed diagnosis of tuberculosis and length of time required to remove the bulk of the lesion (2-hours). Given the significant tuberculosis contact, anti-tuberculous medications were commenced and later ceased when cultures and Quantiferon test were negative. Histology showed a subepithelial
Application of Irwin diagnostic procedures for chronic cough
Guo-fang FENG,Zhong CHEN
Medical Journal of Chinese People's Liberation Army , 2011,
Abstract: Objective To explore the advantages and disadvantages of the diagnostic procedures suggested by the Irwin group,and summarize the experiences in diagnosis and treatment,and to beter understand the etiology,diagnosis,differential diagnosis and treatment of chronic cough.Methods Data of 118 patients,who were finally diagnosed as chronic cough according to the diagnostic procedures suggested by Irwin group in the First Affiliated Hospital of General Hospital of PLA in 2009,were retrospectivety analyzed.Results With the Irwin diagnostic procedures of chronic cough,118 patients were diagnosed definitely.The final diagnostic rate reached 100%.The duration to reach the final diagnosis was 1 day to 30 days.Of the 118 patients with chronic cough,113 were cured(96%).32 cases(27.1%) were caused by asthma and related diseases(allergic rhinitis,allergic pharyngitis,cough variant asthma) and eosinophilic bronchitis;28 cases(23.7%) were due to upper airway cough syndrome and related diseases(chronic rhinitis,sinusitis,pharyngeal bursitis,postnasal drip syndrome,chronic laryngitis,and vocal cord polyps);23 cases(19.5%) due to gastroesophageal reflux disease;14 cases(11.9%) due to lower respiratory tract infection and related diseases(endobronchial tuberculosis,pulmonary tuberculosis,endotracheal mucosal adenocarcinoma,lung cancer,bronchiectasis,and pulmonary fibrosis);10 cases(8.5%) due to cardiac insafficiency;6 cases(5.1%) due to administration of angiotensin-converting enzyme inhibitor(ACEI)-like antihypertensive agents;3 cases(2.5%) were psychogenic cough,and 2 cases(1.7%) were induced by other causes.Conclusions The Irwin diagnosis of chronic cough is a comprehensive and thorough procedure,and it should be used with delibcration in clinic.The etiology of chronic cough is complicated,mainly including asthma and related diseases,sinusitis and upper airway cough syndrome,and gastroesophageal reflux disease.
Chronic Rhinosinusitis in Children  [PDF]
Hassan H. Ramadan
International Journal of Pediatrics , 2012, DOI: 10.1155/2012/573942
Abstract: Rhinosinusitis is a very common disease worldwide and specifically in the US population. It is a common disease in children but may be underdiagnosed. Several reasons may account to the disease being missed in children. The symptoms in children are limited and can be very similar to the common cold or allergic symptoms. Cough and nasal discharge may be the only symptoms present in children. A high index of suspicion is necessary to make the diagnosis of rhinosinusitis in these children. The majority of those children are treated medically. Only a few number will require surgical intervention when medical treatment fails. Complications of rhinosinusitis, even though rare, can carry a high morbidity and mortality rate. 1. Introduction Rhinosinusitis (RS) is a common disease in children that is sometimes overlooked. Children average 6–8 upper respiratory viral illness with 0.5–5% of these progressing to acute rhinosinusitis (ARS). An undefined number of these children will progress to have chronic rhinosinusitis (CRS) [1]. The disease has great impact on the health care system and the national economy as a whole [2]. The clinical symptoms of ARS in children include nasal stuffiness, colored nasal discharge, and cough with resultant sleep disturbance. Facial pain/headache can be present in older children. ARS is defined as symptoms lasting up to 4 weeks, subacute is when symptoms are between 4 weeks and 12 weeks, and CRS is when symptoms have been present for more than 12 weeks [3]. Rhinosinusitis is defined as a symptomatic inflammatory condition of mucosa of the nasal cavity and paranasal sinuses, the fluids within these sinuses, and/or the underlying bone [4]. The term “sinusitis” has been supplanted by “rhinosinusitis” due to evidence that the nasal mucosa is almost universally involved in the disease process [5]. 2. Etiology and Pathogenesis The etiology of CRS is a subject of much debate and ongoing research. The current hypothesis is that of a multifactorial pathogenesis. The paranasal sinuses are a group of paired, aerated cavities that drain into the nasal cavity via the sinus ostia. Several ostia drain in the middle meatus leading to the “osteomeatal complex” (OMC) as the focus of pathology [6]. Though the true anatomic role of the paranasal sinuses is uncertain, their ability to clear normal mucous secretions depends on three major factors: ostial patency, ciliary function, and mucous consistency [4, 7]. Any variety of inciting factors may irritate the sinus mucosa leading to inflammation, edema, bacterial proliferation, outflow obstruction, and
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