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Chronic cough in childhood - A clinical and therapeutic approach

Doina Plesca, Victoria Hurduc, Iulia Ioan, Anca Badarau
Abstract: The article is divided of two parts. In the first part, the authors discuss about the chronic cough, a subject of a great interest in pediatric practice. Physiopathology, the most important etiologic categories, clinical and paraclinical data, principles of therapy of chronic cough are reviewed. The authors underline the importance of the history of the disease, in establishing the cause of chronic cough in children. A cough that worsens at night may be caused by sinusitis, asthma, or gastroesophageal refl ux. The cough that disappears during sleep, suggests a psychogenic cause. Clinical examination has to be thorough, complete and repeated, focused on ENT segment, chest, respiratory and cardio-vascular system. When clinical data and history cannot establish the cause of chronic cough, paraclinical evaluation is necessary. Any child with chronic cough, no matter the age, must have chest X-Ray examination to eliminate aspiration of foreign body or another severe disease (congenital anomaly, cystic fi brosis, bronchiectasis, cardiomegaly, mediastinal mass). In the second part, the authors present the main clinical entities (cough variant asthma and eosinophilic bronchitis, cough during and after respiratory infections, allergic rhinitis, chronic sinusitis and rhinoadenoiditis, passive smoking, gastroesophageal refl ux, bronchiectasis, aspiration syndrome / foreign body aspiration, deglutition diffi culties, vocal cords dysfunction, compression syndrome, psychogenic cough, otogenic causes - Arnold ear - cough reflex, cough as a side effect of the medication) and the etiologic treatment. The indications of an etiologic treatment have to be infl uenced by a detailed history of the disease and by clinical examination. In the absence of an etiologic factor, the patient will receive symptomatic treatment only if the cough is responsible for awakeness, vomiting and fatigue. Tolerability of cough is the element that determines the indications for inhibitors of cough.

Keywords: algorithmic approach to the diagnosis, chronic cough, child


2009-06-01

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