Persistent and prolonged cough in children: differential diagnosis and treatment algorithms

Мизерницкий, Ю. Л.; Мельникова, И. М.

doi:10.21518/2079-701x-2019-17-58-75

Medicinskij sovet

2019

DOI: 10.21518/2079-701x-2019-17-58-75

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Persistent and prolonged cough in children: differential diagnosis and treatment algorithms

Ю. Л. Мизерницкий

И. М. Мельникова

Abstract: The article presents data on the etiology, modern methods for diagnosis and treatment of respiratory system diseases and examines in detail cough as the main symptom. Particular attention is paid to hypertussivity, which is defined as a cough that occurs in the absence of obvious reasons. In addition, the emphasize was put on the role of anatomical and physiological features in the development and characteristics of cough, especially in young children. The authors draw attention to the complex mechanism of the… Show more

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Cited by 6 publications

References 35 publications

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Subacute cough in preschool children: differential diagnostics and differentiated therapy under ambulatory practice

Mokiya-Serbinа¹,

Litvinova²,

Zabolotnyaya³

2021

MPU

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The multifactorial nature of subacute cough, combined with the anatomical and physiological characteristics of preschool children, the impossibility of their full examination in outpatient practice, complicates its diagnosis. An algorithm for the differential diagnosis of acute respiratory infections accompanied by subacute cough in preschool children has been developed, it can contribute to the early identification of its causes and targeted treatment of the disease that caused the cough. A sequence of diagnostic measures is proposed, it includes anamnesis of life and diseases with a list of key questions that should be asked when collecting anamnesis in children with prolonged cough; objective examination of the child; determination of the tactics of further management (inpatient or outpatient); the choice of therapy that is comparable to the intended diagnosis; and evaluation of ongoing therapy. The emphasis is made on the importance of a full-fledged collection of anamnesis, taking into account the data of the time and conditions of the disease, and clinical data for making a presumptive diagnosis in an outpatient practice. It is recommended to carry out trial therapy if the diagnosis is difficult. The article presents modern approaches to the diagnosis of bronchial asthma in children with recurrent virus-induced vising. The modern approaches to the diagnosis and treatment of acute respiratory infections of the upper and lower respiratory tract are outlined in accordance with the principles of evidence-based medicine. It is noted that the most effective methods of treating cough are etiological and pathogenetic approaches, which consist in eliminating or weakening the action of factors that cause cough. It is emphasized that if treatment is impossible or insufficient, symptomatic cough therapy should be carried out. The main directions of symptomatic treatment of cough have been substantiated, which include measures to improve the drainage function of the lungs and restore adequate mucociliary clearance. The expediency of using ambroxol and acetylcysteine preparations was confirmed. Attention is also paid to the use of centrally acting antitussives. Discussion of the problem «to treat or not to treat subacute cough in acute respiratory infection of the upper respiratory tract» from the standpoint of evidence-based medicine is shown. No conflict of interest was declared by the authors. Key words: children, subacute cough, acute respiratory infections.

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Subacute cough in preschool children: differential diagnostics and differentiated therapy under ambulatory practice

Mokiya-Serbinа¹,

Litvinova²,

Zabolotnyaya³

2021

MPU

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Cough. The place of herbal medicine in treatment

Lapidus

2021

Medicinskij sovet

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Cough is one of the auxiliary mechanisms for cleaning the airways from mucus, foreign particles, microorganisms. The physiological cough reflex allows the mechanism of airway cleansing, provided that mucociliary clearance works sufficiently. However, sometimes the cough loses its protective function, becomes persistent, and impairs the quality of life of the patient. In this regard, in the treatment of cough, attention is paid to both secretomotor and secretolytic therapy. Medicinal plants are among the drugs with such properties. Numerous group of drugs containing herbal components has a reflex action, which allows coping most effectively with cough in the initial stages of diseases accompanied by respiratory symptoms. The most common among them and widely used are plantain leaf, coltsfoot leaf, thermopsis herb, ipecacuanha root, marshmallow root, licorice root, anise fruit, thyme (thyme) herb extract, ivy leaf extract. A well-known drug, the active ingredient of which is ivy leaf extract. Its mechanism of action consists in increasing the production of surfactant and increasing the number of β2-adrenoreceptors on the surface of alveolar cells of the bronchial tree, to which ivy active substance α-hederin is attached, which has a bronchospasmodic and expectorant action. Numerous clinical studies have proven a high efficacy and safety of the product based on ivy leaf extract, which allows us to recommend it as the drug of choice for symptomatic cough therapy in both children and adults during acute respiratory infections.

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Pathophysiological and pharmacological concepts in the treatment of bronchopulmonary diseases

Pomortseva

Mikhailov

2022

Medicinskij sovet

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Bronchopulmonary diseases are an urgent problem for practical health care, as they are a frequent complication of acute respiratory viral infections (ARVI), which have a very high incidence in all age groups of the population, and especially among children. The novel coronavirus infection (COVID-19) pandemic, which the world faced in 2019, convincingly confirmed these facts. Therefore, effective pathophysiological treatment of patients with bronchopulmonary diseases is the most important task of modern pharmacotherapy. The 2 most important highly effective mechanisms for protecting the respiratory tract from pathogenic agents that provide the drainage function of the respiratory tract are described: mucociliary transport and cough. When pathological processes occur in the tracheobronchial tree (various bronchopulmonary diseases), the rheological properties of the bronchial secretion, structural and functional characteristics of the mucous membrane and submucosal layer of the airways change. This leads to mucostasis, a violation in the system of mucociliary transport – a key mechanism for protecting the respiratory tract from pathogenic agents, which significantly complicates the course and treatment of bronchopulmonary diseases, because mucostasis contributes to the violation of bronchial patency and the occurrence of atelectasis. Multfactorial is a distinctive feature of changes in mucociliary transport in bronchopulmonary diseases and requires a complex pharmacological action aimed at its normalization. Therefore, pathogenetic therapy aimed at restoring all the key factors of mucociliary transport is targeted in the treatment of various bronchopulmonary diseases. Mucoactive drugs that belong to different pharmacological groups, the use of which is aimed at restoring mucociliary transport, are considered. The necessity of using combined mucoactive drugs for the treatment of patients with bronchopulmonary diseases has been substantiated.

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Persistent and prolonged cough in children: differential diagnosis and treatment algorithms

Cited by 6 publications

References 35 publications

Subacute cough in preschool children: differential diagnostics and differentiated therapy under ambulatory practice

Subacute cough in preschool children: differential diagnostics and differentiated therapy under ambulatory practice

Cough. The place of herbal medicine in treatment

Pathophysiological and pharmacological concepts in the treatment of bronchopulmonary diseases

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