Cough

Types of cough in children. Barking cough in children without fever

Cough, as well as the causes of its occurrence, can be different; it is a kind of way of cleansing the body of accumulations that collect in the respiratory tract - in the lungs, in the bronchi. Phlegm is commonly referred to as the thick liquid produced by coughing, consisting of saliva and mucus. And many doctors confidently claim that the main cause of chronic cough with sputum is long-term smoking.
When a coughing attack begins, you need to give the body a chance to cleanse itself; you cannot hold back, as the functioning of the respiratory system may be disrupted, which entails a risk of infection. Very often, coughing with sputum causes serious complications - breathing problems, hemoptysis, constantly recurring acute respiratory infections, weight loss.
If a person who does not have a tendency to various types of respiratory diseases begins to be bothered by a cough that not only does not stop, but becomes almost chronic, with sputum coming out, you should not hesitate to go to the doctor, since there may already be a threat life, especially if there is an admixture of blood in the sputum or the color of the sputum resembles rust. And if, against the background of a long cough, anxiety, disturbance of consciousness and breathing are felt, then in this case emergency medical care is required, as an acute disorder of the respiratory system can be suspected.
In order not to infect others, when coughing you should wear a bactericidal mask or cover yourself with a handkerchief, spit sputum into a special closed container and maintain personal hygiene.

So, chronic cough with phlegm, what are its causes?

As already noted, first of all, this is smoking, since in the process of smoking mucus is produced in greater quantities than usual, phlegm is produced from mucus, and the body must get rid of phlegm.
In addition to smoking, there are a number of diseases, one of the symptoms of which is coughing with phlegm.
-Bronchial asthma. This disease, which sometimes lasts for many years, begins with the fact that a person simply coughs, and his voice takes on a slight hoarseness. As the disease progresses, wheezing becomes strong, audible in the lungs, and the cough becomes wet with sputum.
-Bronchitis and chronic bronchitis. At the beginning of the disease, the cough is usually dry, turning into wet with sputum, and sometimes with pus.
-Traditional cold, when a mixture of mucus and pus is coughed up.
-Allergic diseases.
-Lung cancer. In its initial stages, it is difficult to diagnose, since the symptoms are very similar to a common cold with an accompanying cough with sputum, when even the attending physician does not always direct the patient to take a blood test for a tumor marker
-Pneumonia. As with bronchitis, the cough is initially dry, and then wet with sputum.
-Tuberculosis. When expectorating in this case, blood may be present in the sputum.

By the way, the sound of a cough and its smell can suggest various diseases. For example, with bronchitis and tuberculosis, the smell when coughing gives off a rotten smell. If the cough is dry, and sometimes barking, then the person most likely has problems with the vocal cords. If the cough is accompanied by a metallic sound, then it is probably a lung disease.
Of course, when the cough continues for a while, it is best to see a doctor as soon as possible. But there are some tips on how to alleviate the patient’s condition at home.
You should drink plenty of fluids to thin out the secretions when you cough with phlegm.
A room humidifier will be useful. The evaporating liquid will soothe inflamed bronchi and lungs and soften secretions.

You should rest as much as possible

You should not smoke during illness, and it is also advisable not to become a passive smoker
During a coughing attack, it is best to straighten up to your full height so that the lungs can expand more easily.
Use of traditional medicines.

If a child has a cough with sputum.

Treatment of cough in childhood has its own characteristics, since the respiratory tract in children is not yet perfect, narrower, in comparison with the respiratory tract of an adult. In this case, blockage of the airways is possible with a strained cough with sputum. If your child is ill, you should not neglect to consult a doctor. Because the causes of cough can be different and, most importantly, do not miss the onset of a serious disease, such as bronchial asthma, in which attacks of suffocation are possible, acute broncholititis, which affects infants, as well as cystic fibrosis, this disease affects a large number of organs and whooping cough , a dangerous infectious disease in which cough lasts up to six months.
In order to help the child cope with the disease and relieve the cough, expectorants and mixtures with a mucolytic effect should be given to him, but the cough should not be suppressed under any circumstances unless there is a special recommendation from a doctor for this.

Cough. carries phlegm (a mixture of mucus and saliva) from the lungs to the mouth, which is the body's way of getting rid of secretions that accumulate in the lungs. Smoking is the main cause of cough with phlegm. Do not try to persuade the patient to hold back his cough. This can impair lung function and increase the risk of respiratory tract infection.

Many people who cough with phlegm do not pay attention to it or consider it normal. They do not see a doctor until they experience serious health problems such as shortness of breath. coughing up blood. chest pain, weight loss, or frequent respiratory problems.

Color and smell of sputum

The color, consistency and smell of sputum are important indicators of a person’s condition. The same applies to the sound of coughing. What do the color and consistency of sputum mean:

Transparent, thin, watery sputum is usually formed with a cold or other upper respiratory tract diseases, asthma, allergies; under the influence of irritants (for example, cigarette smoke).
Thick greenish or yellow sputum indicates sinusitis, bronchitis, or pneumonia.
Brown or reddish sputum usually contains blood. This can be the result of injury caused by coughing, as well as pneumonia, tuberculosis, severe irritation, or even lung cancer.

If a person who usually does not cough develops a persistent cough with sputum, this is an ominous sign - it may be a life-threatening condition. You should urgently consult a doctor, especially if the sputum is bloody, with pus, yellow, greenish or rust-colored.

Urgent medical attention is also necessary for restlessness or clouding of consciousness; if the patient has uneven, rapid or slow breathing. These symptoms indicate acute respiratory distress.

To avoid spreading the infection, the patient should:

When coughing, cover your mouth and nose with a tissue;
always spit sputum into a jar with a lid;
wash your hands often.

Causes of cough with phlegm

The number one reason is smoking. Why? When you smoke, your airways produce more mucus, which in turn creates more phlegm to get rid of. Smoking also paralyzes the fine hairs in the respiratory tract, which normally help remove mucus.

The following ailments also contribute to coughing with phlegm:

Tuberculosis causes:

general malaise;
chest pain;
sweating at night;
shortness of breath.

What does the smell and sound of a cough mean?

An unpleasant, putrid odor can be a symptom of bronchitis, lung abscess, or tuberculosis. A dry cough indicates that the vocal cords are affected, and a metallic tint indicates damage to the main respiratory tract.

Pneumonia can cause:

chills with trembling;
high temperature;
muscle pain;
headache;
rapid pulse;
rapid breathing;
sweating.

Exercises to remove phlegm

If you have a cough with phlegm, special exercises will help expand and clear your lungs and help prevent pneumonia and other lung diseases. To master these exercises, follow these directions:

Lie comfortably on your back. Place one hand on your chest and the other on your upper abdomen at the base of your sternum.
Bend your knees slightly and support them with a small pillow. Try to relax. (If you have recently had chest or abdominal surgery, keep them still with a pillow.)
Exhale, then close your mouth and inhale deeply through your nose. Focus on feeling your belly rise without expanding your chest. If the hand lying on your stomach rises when you inhale, then you are breathing correctly. Use not only the chest muscles to breathe, but also the diaphragm and abdomen. Hold your breath and slowly count to five.
Close your lips as if to whisper and exhale completely through your mouth without puffing out your cheeks. Use your abdominal muscles to push out all the air, keeping your ribs down and inward. Exhalation should take twice as long as inhalation.
Rest for a few seconds. Then continue the exercise until you have done it correctly five times. Gradually increase the number of repetitions to ten. Once you have mastered this exercise, you can do it sitting, standing, or lying in bed. During the day, try to breathe deeply every hour or two.

These exercises, like the ones described above, will help clear secretions from your lungs and prevent lung infections. Read the following guidelines to learn the correct technique:

Sit on the edge of the bed, leaning forward slightly. If your feet do not reach the floor, place a stool. If you feel weak, rest your hands on the nightstand with a pillow on it.
To stimulate the cough reflex, breathe deeply and exhale through pursed lips. Exhale completely through your mouth without puffing out your cheeks. “Squeeze out” the air using your abdominal muscles.
Inhale again, hold your breath, and cough twice vigorously (or, if you can't, three times gently), focusing on getting all the air out of your chest.
Rest briefly, then perform the exercise at least twice. Repeat this at least once every two hours.

Other self-help measures:

Drink more fluids to thin out lung secretions and make them easier to drain. However, if fluid has accumulated in the lungs (pulmonary edema), consult your doctor first.
Use a room humidifier. This will soothe inflamed airways and soften dried secretions.
Get plenty of rest.
Avoid pulmonary irritants - especially tobacco smoke.
When coughing, stand or sit up straight to help your lungs expand.
You can use medicines and mixtures.

Humidify the air. To soothe airway inflammation and prevent lung secretions from drying out, talk to your doctor about using a room humidifier.

What will they say at the hospital? The patient may be prescribed medications that dissolve phlegm (mucolytics); helping to clear mucus from the lungs (expectorants); dilating airways (bronchodilators). Antibiotics are prescribed to treat the bacterial infection that is causing the cough.

If your child has a cough with phlegm

Because children's airways are narrow, a child who coughs up phlegm may have a blocked airway and have difficulty breathing if the phlegm builds up. Therefore, it is necessary to consult a doctor.

Reasons that cause a child to cough with phlegm:

asthma is a chronic lung disease that causes repeated bouts of difficulty breathing;
acute bronchiolitis - a viral disease of the lower respiratory tract (occurs mainly in children from two months to one year);
cystic fibrosis is a chronic disease that affects many organs; Whooping cough is a highly contagious respiratory disease that causes sudden bouts of high-pitched coughing.

To clear mucus from your child's airways, your doctor may prescribe an expectorant. Use the medicine strictly as prescribed by your doctor. Do not give your child other medicines—such as cough suppressants—unless your doctor tells you to. Suppressing a cough may worsen the patient's condition.

Cough is a natural reflex phenomenon that occurs when the mucous membrane of the respiratory tract is irritated by vapors of substances or foreign bodies. The symptom appears as a defensive reaction in which the respiratory tract is rid of sputum or dust in order to achieve normal breathing.

The symptom manifests itself not only in the form of a dry or wet cough. It also has other characteristics that affect the patient’s condition. A persistent cough can occur during pathological processes (pneumonia, acute respiratory viral infections, bronchitis, etc.) and mechanical damage to the tract from food, dust or foreign bodies.

Etiology

Many people are interested in the question of how to treat a cough in a child or adult patient. But before looking for therapy, the doctor and the patient need to understand why the symptom arose. A sore throat and cough occur under the influence of various factors, which in medicine are divided into several categories:

mechanical - foreign bodies in the respiratory tract, ear canal, enlarged lymph nodes, inflammation of the trachea and bronchi;
allergic;
chemical - exposure to chemical vapors;
thermal - at low temperature.

Often a cough does not go away and may appear again due to the fact that it irritates the cough areas - the posterior wall of the larynx, pleura, branching of the trachea and bronchi.

Cough in children and adults cannot be ignored, since the symptom may manifest itself in a more severe form, when the symptom already indicates chronic or serious health problems. Before starting treatment with folk remedies and medications, doctors need to understand what ailment the symptom indicates.

A cough that is wet, dry or of any other nature indicates the following pathologies:

- manifests itself as a dry cough, which develops into a wet one;
- barking cough, hoarseness of voice;
- rough, severe pain is felt when coughing;
acute bronchitis - severe cough with sputum production;
- a painful attack of cough, first dry, and then wet with phlegm;
and - attacks at night, when nasal discharge irritates the back wall of the pharynx.

As for newborns, the reasons for the appearance of symptoms in them differ from adults. Often, a baby’s cough appears after feeding, when milk enters the respiratory tract. It also appears during strong salivation during teething. Coughing after eating and with excessive salivation is not a pathological process and therefore does not require treatment.

Classification

Based on the nature of cough, clinicians have identified two types of symptoms:

- no sputum. It is divided into two forms - accompanied by painful attacks or sore throat, decreased voice volume. And also paroxysmal - characteristic of tracheitis and bronchitis;
- accompanied by expectoration, wheezing, heaviness and an unpleasant sensation in the chest. Marked at and.

Depending on the duration of the course, a severe cough in a child and an adult can take the following forms:

acute - lasts no more than three weeks for infectious diseases;
- exceeds the duration of the acute form by several weeks. This type of cough occurs with pathology of the bronchi and lungs, with the accumulation of mucus in the nasopharynx, with mental disorders and frequent use of medications.

By frequency we identified:

regular - manifests itself in severe attacks during which a person cannot breathe normally. In a child and an adult, such a cough can lead to vomiting, respiratory arrest and fainting;
temporary - a single coughing attack without side effects.

Dry cough

Many people believe that if a cough does not go away for a long time, then this already indicates a pathology, but this is not so. This symptom is a protective reflex in response to various stimuli.

In medicine, it is believed that the dry type of cough is the safest and can be quickly cured. The cough does not manifest itself in the release of mucus or sputum from the lungs. The patient feels only a slight sore throat, as well as other symptoms:

barking character;
high temperature;
difficulty breathing;

These unpleasant manifestations not only indicate a developed illness in the body, but also lead to insomnia, headaches and nervous breakdowns. Clinicians argue that a non-productive, that is, dry, attack is more exhausting for the body than the other type.

The treating doctor, before determining how to quickly cure a cough, must determine the cause of the symptom. Quite often, this symptom appears in heavy smokers, but there are other root causes for the appearance of the symptom:

respiratory tract infections;
allergies;
inflammation of the pharyngeal mucosa;
pneumonia;
inflammation in the trachea;
bronchial asthma;
tumors.

A child's cough without fever may manifest itself as a consequence of passive smoking. Doctors have long been saying that a person who stands next to a smoker is also exposed to smoke. Therefore, a child may develop a cough that does not go away for a long time and does not indicate the development of pathologies.

Before starting treatment for cough in an adult or child, the patient needs to undergo a series of examinations to establish the exact cause of the appearance of such a symptom. After conducting diagnostics and establishing an accurate diagnosis, the doctor can decide how to quickly cure a cough at home.

With timely initiation of therapy, the patient’s condition immediately improves and obvious symptoms subside. To eliminate cough, various treatment methods are prescribed:

use of medications;
physiotherapy;
inhalation therapy.

As part of drug treatment, the following drugs are prescribed:

antispasmodics;
thinning phlegm;
dilating bronchi;
decongestants;
sedatives;
antitussives;
antibacterial.

If a cough in an infant or an older patient is due to allergies, then the patient is prescribed antihistamines, sorbents and bronchodilators.

Wet cough

To answer the question of how to treat a wet cough in a child, the doctor first needs to diagnose this illness in the person. It may be accompanied by the appearance of such a clinic:

sudden attacks of coughing;
dyspnea;
high temperature;
loss of appetite;
wheezing;
blood in the sputum;
greenish sputum;
chest pain;
night cough.

Cough and sniffles, which occur with other symptoms, are characteristic symptoms of such pathologies:

and ARVI;
bronchitis;
pneumonia;
bronchial asthma;
allergies.

Sputum with this symptom is detected in different types. Clinicians have identified 6 main types of mucus:

abundant;
with a rusty tint;
watery;
viscous;
mixed with blood;
purulent.

When a patient has a cough with sputum, the question arises how to cure the cough at home. Only a doctor can give an answer, since treatment for a symptom directly depends on the intensity of the manifestation and type.

During treatment, the patient is allowed to adhere to the following measures:

The use of folk remedies is allowed, namely hot tea with lemon, raspberries, honey, lingonberry syrup or hot milk. Each remedy is aimed at thinning sputum;
humidify the air regularly.

As for medications, doctors prescribe medications that improve the expectorant effect and thin the mucus.

To cure a cough in a 1-year-old child, parents are allowed to massage the chest and back. This effect on the lungs and bronchi improves the discharge of sputum. A coughing baby can also clear his throat on his own during active play. This therapy process is considered much better than taking medications.

It is recommended to treat cough in a child over 3 years old with inhalations. Preference is given to inhalation through a nebulizer. This device sprays the medicinal substance with which it is filled and facilitates the delivery of the drug directly to the bronchi. However, before treating children, you should consult a doctor, especially if the child is 2 years old. Otherwise, the child may continue to cough until he vomits for a long time.

When choosing medications for a child, you need to be very careful so that they do not harm the body. In medicine, there are drugs that can treat cough in a 2-year-old child. All these medicines will be based on plant extracts and active ingredients. Also, all medications for children at this age are offered in the form of syrup, which is convenient to take several times a day.

Cough without fever

People are accustomed to the fact that if a person gets sick, his body temperature always rises, his condition worsens, a cough, runny nose and other symptoms appear. However, doctors say that there are pathologies that manifest themselves with a slight increase in grades or, without any increase at all.

Cough without fever occurs with the same pathological processes as described above. However, the patient is not bothered by one of the many symptoms. Cough without fever manifests itself in the following pathologies:

cold;
allergy;
stress;
cancer;
heart pathology;
diseases of the ENT organs;
tuberculosis;
thyroid diseases.

Quite often, a cough without fever occurs in children who have just had an acute respiratory viral infection. This is due to the high level of vulnerability and sensitivity of the respiratory tract mucosa. What to do in this case? Doctors claim that there is nothing pathological in this process. It is enough for the child to follow all the recommendations of doctors and continue the course of treatment. With such an illness, it is not advisable for children to go to a group, but it is better to sit at home for two or three days in order to finally recover from the infection. Otherwise, the child may develop chronic inflammation or complications.

Cough during pregnancy

During pregnancy, women's bodies become very vulnerable. Therefore, even short contact with sick people can contribute to the disease. A cough is only a symptom of a particular pathology, so if such a symptom is detected, you need to look for the root cause, and not try to get rid of the unpleasant symptom.

If a woman has a symptom due to illness, then the question remains how to treat a cough during pregnancy so as not to harm the baby. The best place to look for an answer is in a doctor's office. To eliminate the symptom, the patient is prescribed gentle syrups, tablets and vitamins. Under no circumstances should a woman apply cupping or mustard plasters, take a hot bath or steam her feet to warm up. You also need to be careful with the dose of vitamin C.

So how to treat cough during pregnancy at home? Despite all the prohibitions that the doctor imposes on treatment, the woman is recommended to undergo simple physiotherapeutic procedures. At home, you can do inhalations with different herbs and gargling.

Doctors do not particularly recommend the use of alternative treatments, but several methods remain available and approved. At the appointment, the doctor can tell you how to treat a cough with folk remedies and how often they can be used.

For cough treatment it is recommended to use:

honey - grind on the chest, make compresses, eat a few teaspoons, add to tea;
milk - drink slightly warmed, you can add sage, figs;
garlic and onion - chopped vegetables, take one spoon three times a day.

Prevention

To prevent the recurrence of cough, doctors advise what can be done for prevention:

eat healthy food;
do not smoke and avoid inhaling cigarette smoke;
treat illnesses in a timely manner;
observe the rules of hygiene;
during the cold season, do not overcool.

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Cough– a jerky, sharp release of air from the respiratory tract. A cough appears when nerve receptors are irritated against the background of changes in different parts of the respiratory system, as well as when the cough center in the brain is excited and the external auditory canal is irritated.

Under the influence of infection, the mucous membrane becomes inflamed, which leads to an increase in the amount of sputum in them and a slowdown in its evacuation.

In preschool children, cough and obstructive syndrome are caused by swelling of the mucous membrane and accumulation of viscous sputum. And in children over 5-6 years old, spasm (narrowing of the lumen due to contraction of the muscle fibers of the bronchial wall) of the bronchi is more pronounced. This should be taken into account when choosing treatment.

Rare episodes of coughing can occur in a healthy child, for example during sleep when mucus accumulates in the larynx.

Types of cough

Coughing– short repeated episodes of cough as a result of accumulation of mucous discharge in the larynx. Occurs with pharyngitis, mild bronchitis, as a habit after suffering from bronchitis;
Wet cough characterized by the discharge of sputum, which, accumulating in the respiratory tract, irritates the unequal receptors of the walls of the bronchi, trachea, larynx and pharynx. Occurs on the 4-8th day from the onset of acute bronchitis, with pneumonia;
Dry unproductive- without mucus discharge, unpleasant, intrusive, irritating. Appears with laryngitis, at the onset of bronchitis, aspiration (inhalation) of a foreign body, on the 2nd day from the onset of pneumonia. Healthy children may experience this when moving to a warm room from the cold.
Laryngeal appears in diseases of the larynx (laryngitis, diphtheria). This is a hoarse, “barking” cough; with diphtheria it becomes almost silent;
Bitonal- with a hoarse low sound at the beginning and a whistling high sound at the end. Appears when the lumen of large bronchi narrows (foreign body, bronchitis);
Paroxysmal- in the classic version, it occurs with whooping cough, when several coughing shocks are followed by a deep breath with a whistle (reprise). During an attack, the face turns red or blue, tears flow from the eyes, and there may be vomiting at the end. Attacks occur more often at night;
Whooping cough appears in the presence of thick viscous sputum. It is similar to the paroxysmal cough of whooping cough, but does not have recurrences. Occurs in cystic fibrosis;
Spastic— appears in a child with obstructive diseases (bronchial asthma, obstructive bronchitis). This is an obsessive non-productive cough with a whistling sound. Intensifies with deep breathing.
Psychogenic dry cough appears in emotional children when they want to attract the attention of adults, in various stressful situations (while waiting for a doctor’s appointment at the clinic), or with excessive restless attention of the mother to the symptoms of a cold. This cough goes away when the child is left alone and adults do not concentrate attention on it.

Diseases associated with cough

Disease	Character of the cough	Associated symptoms
Bronchitis	Dry at first, later becomes wet	Fever, loss of appetite, headache.
Obstructive bronchitis	Spastic	Increased body temperature, rapid breathing, noisier exhalation, when breathing, the nostrils flare, the intercostal spaces are drawn in. The child is irritable and restless.
Pneumonia	Dry	Increased body temperature and chills, weakness, loss of appetite.
Bronchial asthma	Spastic dry, often at night	During an attack: the child is excited, the intercostal spaces are drawn in when breathing.
Pharyngitis	Unproductive dry, may worsen with crying, laughing, changes in air temperature	Sore and red throat, pain when swallowing, possibly increased body temperature.
Laryngitis	Laryngeal, dry	Possible increase in body temperature, hoarse voice.
Tracheitis	Dry, unproductive, may be whooping cough	Possible fever, symptoms of intoxication (headache, weakness).
Whooping cough	Unproductive dry turns into paroxysmal	Fever, runny nose, after several coughing shocks there is a deep noisy breath (reprise), there may be vomiting during an attack. Coughing attacks can continue for a month or more.
Cystic fibrosis	Whooping cough	Diarrhea, foul-smelling stool, delayed physical development, low body weight.
Rhinitis	Unproductive dry	Nasal congestion, watery nasal discharge, nasal sound, possible snoring.
Gastroesophageal reflux disease (in young children)	Morning	Excessive regurgitation, frequent vomiting, hiccups, abdominal pain.
Foreign body in the respiratory tract	Bitonal, paroxysmal	Appears against a background of general well-being, characterized by shortness of breath and hoarseness.

The table lists the most common causes of cough in children, but many other diseases may also cause a child to cough.

For example, with ascariasis, during the migration of larvae throughout the body and their passage through the lungs, there may be a dry cough.

ARVI (acute respiratory viral infections) occur with symptoms of pharyngitis, laryngitis, tracheitis and even bronchitis.

Inhalation of smoke and aerosols of other irritants may cause a child to cough severely.

In chronic adenoiditis (inflammation of the adenoids), the cough appears during sleep, is accompanied by snoring, and the child sleeps with his mouth open. This manifestation also occurs with sinusitis.

Treatment

To cure a cough, you need to determine its nature, and the choice of medications depends on this. So, a dry cough must be converted into a wet one with good sputum discharge; in case of a painful paroxysmal cough, the frequency of cough impulses must be reduced, etc.

Types of medications for treatment:

Antitussives– drugs that reduce the intensity of cough by inhibiting the cough center in the brain (central acting drugs) or by inhibiting the cough reflex as a result of reducing the sensitivity of receptors in the respiratory tract (peripheral acting drugs).
These drugs are prescribed only for excruciating, painful dry cough, which exhausts the child, disrupts his sleep and worsens his general condition. As a result, there is no complete removal of mucus from the respiratory tract; it irritates the receptors even more, and the cough only intensifies.
Characteristic of the initial stage of bronchitis, laryngitis, tracheitis.
Such drugs include Sinekod, Tusuprex, Sedotussin. Taking these drugs if you have airway obstruction syndrome is contraindicated!
Enveloping agents used for coughs caused by irritation of the upper respiratory tract (rhinitis, pharyngitis). For this purpose, herbal preparations, teas, syrups, and various lozenges are used.
Expectorants stimulate the removal of viscous sputum by diluting it due to an increase in volume. Herbal extracts (elecampane, thyme, marshmallow, plantain, anise), potassium and sodium iodides have these properties. But these drugs can cause allergies in a child, and therefore their use in children, especially young children, is limited.
Mucolytic drugs lead to the dilution of sputum, but almost do not increase its volume. They are taken for diseases accompanied by a wet cough with thick, difficult to separate, viscous sputum.
Preparations based on ambroxol not only dilute sputum, but also enhance its excretion. These include Ambroxol, Ambrobene, Halixol, Flavamed, Lazolvan and others. A similar effect is typical for carbocysteine preparations: Mucopront, Fluditec.
Acetylcysteine preparations (ACC, Mukobene) strongly dilute sputum, but do not remove it, so their use in children is not recommended.
Combination drugs along with inhibition of the cough reflex, the viscosity of sputum is also reduced. These include Tussin Plus, Glycodin, Stoptussin.
And Bronholitin also has a bronchodilator effect.
Drugs with indirect action help stop coughing by affecting additional causes of its development. First of all, these are bronchodilators, drugs that expand the lumen of the bronchi. Indicated for obstruction to relieve bronchospasm. Among these drugs are Salbutamol, Berodual, Clenbuterol, Atrovent.
Antihistamines(allergy medications) can help in some cases reduce cough by reducing swelling of the mucous membrane. These are various drugs: Fenkarol, Fenistil, Zyrtec, Parlazin, Erius.

The use of mucolytic drugs simultaneously with antitussives is contraindicated due to the possibility of “swamping” of the respiratory system (the cough reflex is inhibited, liquid sputum is not removed.)

To treat cough, you can use not only medications in the form of tablets, syrups, powders, but also in the form inhalations. It is best to use compressor-type inhalers (nebulizers) for these purposes.

To moisturize the mucous membrane of the respiratory tract and facilitate the removal of sputum, you can alkaline inhalations(mineral water Borjomi, Essentuki).

Solutions are used to thin sputum. ambroxol inhalation.

To facilitate coughing up sputum, it is necessary to postural drainage. The child lies on his stomach, the upper body should be slightly lower. The adult folds his palm in the shape of a boat and begins to tap the child’s back with the palm side. This method is used for bronchitis and pneumonia.

As you have already seen, the list of drugs for treatment is very large. Therefore, a doctor will help you decide how to treat a cough and, after an examination, will prescribe the correct treatment for your child.

Use of traditional medicine

To help with basic treatment, you can use various medicinal herbs and infusions. But it should be remembered that this type of treatment is not recommended for children under 5-7 years of age, since herbs are a rather strong allergen.

Expectorant and antitussive preparations:

№	Compound	Directions for use
1	Common coltsfoot, leaves – 20 g. Althaea officinalis, roots – 20 g. Oregano, grass – 10 g	Take half a glass 2 hours before meals.
2	Common coltsfoot, leaves – 20 g. Large plantain, leaves – 20 g. Licorice naked, roots – 20g. Violet tricolor, grass – 20g.	Leave in a water bath for 15 minutes, strain. Take ¼ cup warm 5 times a day before meals.
3	Elecampane, rhizome and roots, 20g	Pour a glass of water, boil over low heat for 30 minutes, take 4 tablespoons per day.
4	Thyme, grass – 20g	Leave in a water bath for 15 minutes, cool, strain. Take 1-2 teaspoons.

Features of the disease and its treatment in infants

In infants, the equivalent of a cough may be sneezing.

By taking phlegm thinners, we want to make it easier to remove. But for babies, things are a little different. Children of this age cannot yet fully cough. And it turns out that sputum accumulates more and more in the respiratory tract, contributing to the worsening of the disease. For this reason, very often in children, bronchitis can turn into pneumonia.

To avoid this, you need help the child clear his throat. To do this, you need to press with a flat, blunt object (the tip of a spoon, a spatula) on the root of the tongue. Do not be alarmed if your baby may vomit at the same time; this will also remove excess phlegm from the digestive tract, because the child swallows some of it (children also do not know how to spit). This procedure needs to be done quite often, always before each feeding.

Of the medications for children in this group not recommended use acetylcysteine preparations (ACC). When taking medications in the form of syrups, you need to pay attention to the fact that the dyes and sugar used in their production can cause allergies.

Refers to the most common symptoms in medical practice. There are many causes of cough. To determine the cause of cough, its qualitative and quantitative characteristics are of great importance. By conducting a thorough analysis of the characteristics of cough, in 70-80% of cases it is possible to determine the etiology of cough even before the start of an objective examination of the patient.

Depending on the cause of the cough, therapeutic measures are determined.
Sometimes it is enough to eliminate the causative factor (for example, discontinue medications - angiotensin-converting enzyme inhibitors or remove the accumulation of earwax from the ear canal). In another case, it may be necessary to stimulate expectoration, in a third, suppression of the cough reflex, etc.

The mechanism of cough.

Cough is a protective-adaptive reaction of the body.

Cough is necessary:

To cleanse the respiratory tract of foreign substances (mucus, sputum, blood, pus, etc.);
To prevent mechanical obstruction in the airways.

The coughing act involves the muscles of the larynx, vocal cords, trachea, bronchial muscles, and abdominal muscles.

The sequence of cough occurrence is as follows:

Take a deep breath -> the muscles of the larynx contract -> the vocal cords close -> the tone of the bronchial muscles increases -> the expiratory muscles (abdominal) contract when the glottis is closed -> intrathoracic pressure increases to 100 mm Hg. Art. -> the trachea narrows due to the bending inward of the posterior membrane -> then an instant opening of the glottis -> forced exhalation -> a strong air flow occurs, the speed of which can reach the speed of sound -> compressed air from the respiratory tract is pushed out through the mouth -> foreign substances from respiratory tract, a stream of air is carried into the oral cavity and removed outward.

During the exhalation phase, the cough may be intermittent and consist of several repeated shocks. This promotes the separation of phlegm and foreign bodies from the walls of the bronchi and their movement towards the trachea and larynx.

After the completion of a rapid exhalation, a single act of coughing ends, which can be repeated several times (cough reprise).

In the presence of a tracheostomy, the effectiveness of coughing is reduced due to leaky closure of the glottis.
In addition, the high pressure that is created behind the closed glottis can interfere with venous filling of the heart and lead to a decrease in cardiac output and even the appearance of "".

The cough reflex arc consists of the following components:

Peripheral receptors that respond to various stimuli (inflammation, chemical, mechanical, thermal irritation);
Afferent nerve fibers that transmit these impulses to the brain;
“Cough center” in the medulla oblongata, where impulses arrive from the periphery. In addition, the “cough center” receives impulses from the higher centers of the cerebral cortex.
Efferent nerve fibers along which impulses travel from the medulla oblongata to the periphery.
Effector muscles that, when contracted, cause coughing.

The cough reflex is under the control of the cerebral cortex. The cough can be induced or suppressed voluntarily.
A reflex cough begins with stimulation of peripheral receptors. These receptors can be stimulated by mechanical irritants (mucus, dust, foreign bodies), chemical irritants (smoke or gases with a strong odor) or thermal irritants (hot, cold air). These receptors are also affected by edema, hyperemia, and exudative processes during inflammation of the airways.

In most cases, cough occurs when receptors in the respiratory tract and pleura are irritated, and occasionally when the centers of the brain (the so-called central cough) or receptors located outside the respiratory tract (in the external auditory canal, esophagus, etc.) are stimulated. An example of a central cough is a psychogenic one (or, as it is otherwise called, a neurotic cough).

The intensity and frequency of cough depends on the strength of the stimulus, its location, as well as on the excitability of cough receptors (which varies widely among different patients).

Causes of cough

Acute cough in the vast majority of cases is caused either by self-limiting viral infections of the upper respiratory tract, or by acute infectious (viral and bacterial) and non-infectious lesions of the lower respiratory tract (tracheitis, pneumonitis).

Causes of chronic cough

Most common:

Smoking (and inhalation of other irritants);
Transient increase in airway reactivity (for example, after viral infections of the upper respiratory tract);
Bronchial asthma;
Drainage of mucus (discharge) down the back wall of the throat;
Gastroesophageal reflux;
Chronic bronchitis

More rare:

Interstitial lung diseases;
Bronchiectasis;
Lung abscess;
Tuberculosis and other chronic lung infections;
Cystic fibrosis (cystic fibrosis of the lungs);
Recurrent aspiration;
Foreign body in the airways;
Congestive heart failure;
Lung cancer;
Use of medications (for example, angiotensin-converting enzyme inhibitors, β-blockers, etc.);
Compression of the respiratory tract (for example, an enlarged thyroid gland, aortic aneurysm, etc.);
Irritation of cough receptors in the external auditory canal (accumulations of earwax, hair, etc.);
Psychogenic cough;
Opportunistic infections (Pneumocystis carinii and other microorganisms) in patients with a compromised immune system (for example, in HIV-infected patients, i.e. infected with the human immunodeficiency virus).

Differential diagnosis

Cough is distinguished:

Strong and weak;
Rare and common;
Painless and painful;
Periodic and permanent;
Dry and wet.

A wet cough can be non-productive (sputum is not coughed up) and productive (accompanied by sputum production).

The reasons for the lack of sputum when coughing can be:

The secretion of the tracheobronchial tree is too viscous;
Sputum is produced in small quantities;
The patient is weakened;
Sputum is swallowed, which is typical for children and women.

The clinical characteristics of cough depend on the time of appearance, duration, sonority, presence or absence of expectoration and other factors.

The number of possible diagnoses can be significantly limited once the following questions have been answered:

Is the cough acute or chronic;
Whether it is productive or unproductive.

Anamnesis

Character of the cough

Some patients have the habit of “clearing their throat,” but due to a misunderstanding, they call it a cough. In fact, this symptom is most typical for a situation associated with drainage of discharge down the back wall of the pharynx - both during the period of seeking medical help and in the (distant) past. In such cases, it is advisable to ask the patient to cough. This simple technique often allows you to differentiate a dry cough from a wet cough and from “clearing your throat” by its sound.

Great importance is attached to the qualitative characteristics of the cough.
A single attack of severe cough occurs when inhaling smoke and other irritating substances, or foreign bodies or pieces of food entering the respiratory tract.

A dry, short and frequently recurring cough is heard in inflammatory diseases of the pharynx, tracheobronchitis and in the initial stages of pneumonia.

A loud, rough “barking” cough can occur when the epiglottis is involved in the pathological process, in particular in children with. As a rule, it is combined with hoarseness or aphonia.

Typical of whooping cough is a kind of convulsive or convulsive cough that occurs in paroxysms, often at night. It is characterized by several coughing impulses following each other, interrupted by long and loud breaths. Coughing attacks are often repeated (reprise) and are accompanied by vomiting.

A cough, combined with an acute rise in body temperature and hoarseness of voice, is often observed with viral tracheobronchitis.
A long, noisy, convulsive sigh during a coughing attack also occurs with inflammation of the trachea and larynx.

Paralysis of the vocal cord abductor muscles causes a prolonged bull's cough. It owes its name to its peculiar sound symptoms, reminiscent of the lowing of cattle. Most often, it occurs when the left recurrent laryngeal nerve is compressed by various intrathoracic formations: tumors of the lungs or esophagus, enlarged lymph nodes of the lung root, or an aortic aneurysm.

If such intrathoracic formations compress the trachea, but do not touch the nerve, the cough takes on a sharp metallic hue. Some patients in such situations (as well as with damage to the pleura, mediastinum, or foreign bodies entering the respiratory tract) develop a painful, annoying dry cough (also known as irritation cough, useless cough).

In children with tumorous bronchoadenitis, a bitonal cough appears, in which a musical high overtone is added to the rough fundamental tone.

Unilateral laryngeal abductor palsy does not affect the voice. Moreover, the voice often does not change even with combined unilateral paralysis of the abductor and adductor muscles of the larynx.

Weakness of the pectoral muscles due to polyneuritis or muscular dystrophy will reduce the speed of air movement when coughing, which becomes silent. Similar disturbances are observed with general weakness, exhaustion, toxemia, deep disturbances of consciousness, and in the presence of a tracheostomy.

A constant, mild cough (coughing) occurs in chronic diseases of the pharynx and larynx, congestive bronchitis (with chronic circulatory failure), and pulmonary tuberculosis.

Duration of cough and association with viral upper respiratory tract infections.

Currently, there is no generally accepted distinction between acute and chronic cough. Most published proposals are to consider a cough to be chronic if its duration exceeds 3-8 weeks. The second number is more consistent with this concept.

A cough lasting less than 8 weeks that develops after an acute respiratory viral infection probably reflects a state of increased airway reactivity associated with the illness.

With an exacerbation of chronic obstructive pulmonary disease, a cough is provoked even by mildly irritating odors and changes in the temperature and humidity of the inhaled air, which is associated with an increase in the sensitivity of cough receptors.

A nonproductive cough that lasts for years appears to be a kind of “habit” that has become established in the patient under the influence of psychogenic factors.

Time of cough onset

Cough in the morning is typical for patients with chronic bronchitis, sinusitis, allergic and vasomotor rhinitis. On the contrary, a cough with a pronounced nocturnal component is consistent with diagnoses of bronchial asthma (in which case hoarse breathing is not an obligatory symptom), congestive heart failure, or gastroesophageal reflux.

Smoking patients with chronic bronchitis typically cough up mucus in the morning, which forms and accumulates in the respiratory tract at night.

The cough that occurs in the initial period of acute laryngitis, tracheitis, bronchitis, pneumonia is usually dry. In typical cases, sputum appears after a short period of time.

Sputum

Expectorated sputum is formed as a result of the displacement of mucus secretions of the lower respiratory tract with secretions from the nose, pharynx and saliva.

The visco-elastic intrabronchial mucus has 2 layers.

A layer with low viscosity and high elasticity is attached to the cilia of the epithelium, and above it there is a more viscous layer. The inner (liquid) layer is called the sol, the outer (insoluble) layer is called the gel.

The composition of the sol, in addition to water, includes electrolytes, biologically active substances, enzymes and their inhibitors, individual components of blood serum, etc. The gel is represented by drops and lumps of mucus deposited on the surface of the sol. Although airway mucus is 95% water, its physical properties are determined by the glycoproteins it contains.

Several glycoproteins (sialic acid, sulfur-containing protein, etc.) are found in human bronchial mucus, which are produced in various combinations in mucus-secreting cells. Neutral and acidic glycoproteins (mucins), the proportion of which in mucus does not exceed 2-3%, are part of the gel.

Other types of cells of the glandular apparatus of the bronchi produce serous fluid. Bronchial secretion is formed by mixing the transudate component of mucus (water, lipids, proteins) with serous fluid and glycoproteins.

In diseases of the respiratory tract, the qualitative composition of bronchial secretions changes.

Thus, greater formation of glycoproteins (with a shift towards the predominance of neutral mucins and a decrease in acidic mucins) is observed in chronic bronchitis, and greater formation of transudate is observed in bronchial asthma.

An increase in the content of neutral glycoproteins in chronic bronchitis leads to an increase in the viscoelastic properties of bronchial secretions.

During infections, the production of both glycoproteins and transudate increases. The breakdown of leukocytes in bronchial mucus increases the DNA content in sputum, which directly affects its viscosity. The accumulation of decayed cells and microorganisms turns the infected mucus yellow, and the subsequent action of verdoperoxidase (a leukocyte enzyme) gives it a greenish color.

Uninfected sputum is usually clear, white, and jelly-like. Extremely viscous glassy mucous sputum occurs in patients with bronchial asthma. Sometimes balls and branched mucus plugs are found in it, which are presumably casts of small bronchi. With bronchopulmonary aspergillosis, such balls or casts become dark brown in color.

City dwellers and people living in dusty conditions may have sputum of various shades of gray. Miners sometimes cough up tar-black mucus (melanoptitis). This is observed when fibrous foci in the lungs are destroyed and the contents enter the bronchi. With pulmonary edema, the sputum is foamy and pink in color.

In most lower respiratory tract infections, pus is mixed with the mucus to form purulent-mucous sputum. With a lung abscess and from bronchiectasis cavities, pus is sometimes coughed up without any admixture of mucus. Unpleasant odor of sputum, especially in the last two cases, is often due to anaerobic infection. Coughing up purulent brown sputum is rare and usually indicates the presence of an amoebic lung abscess (typically secondary to hepatic amoebiasis).

Thick, viscous, “rusty” sputum is characteristic of pneumococcal pneumonia. Raspberry jelly-type sputum may be a manifestation of Klebsiella pneumonia or a late symptom of bronchogenic cancer.

Bloody sputum is specific for bleeding. However, in many studies, the cause of hemoptysis can be determined in approximately 50% of cases. Old, healed and calcified tuberculous lesions may cause hemoptysis simply because they are surrounded by local bronchiectasis, although the possibility of reactivation of tuberculosis should not be overlooked.

Other possible causes of bloody sputum include pulmonary embolism, decompensated congenital heart defects, lung tumors and other diseases.

In addition to the appearance of sputum, its quantity also matters. Pulmonary edema quickly leads to the formation of large quantities of pink, frothy sputum.

An unusually large amount of sputum is also produced when:

common bronchiectasis (for example, cystic fibrosis);
breakthrough of a lung abscess into the bronchus;
with a rare form of carcinoma arising from alveolar cells.

The amount of sputum in chronic bronchitis and bronchial asthma varies widely, but in some patients it can also be significant.

Factors that increase cough

Understanding these factors can provide the physician with very valuable information.

For example, the cough gets worse:

In patients with bronchial asthma after physical activity or when inhaling cold air;
For gastroesophageal reflux or aspiration of food - after eating.

In general, coughing attacks after eating require the exclusion of diseases of the pharynx and esophagus: tracheoesophageal fistula, hiatal hernia, esophageal diverticula, as well as neuromuscular diseases leading to aspiration of mucus.

The occurrence of a cough after a change in body position is typical for patients with a lung abscess or bronchiectasis. In addition, patients with bronchiectasis are characterized by free coughing up of sputum at any time of the day. After removing irritating products accumulated in the bronchi (sputum, pus, etc.), the cough stops.

Presence of other symptoms of the disease

Valuable diagnostic information is obtained by taking into account and analyzing other symptoms of the disease.

Thus, wheezing, attacks of suffocation and shortness of breath indicate bronchial asthma.

A feeling of nasal congestion, pain and a feeling of heaviness or pressure in the paranasal sinuses, or mucus running down the back of the throat are characteristic of rhinitis and sinusitis.

Gastroesophageal reflux is often combined with heartburn, regurgitation, attacks of asphyxia at night or a sour taste in the mouth in the morning.

Chronic circulatory failure is characterized by shortness of breath on exertion, orthopnea (a forced sitting position that the patient takes to relieve severe shortness of breath) and swelling in the lower extremities.

Cough combined with hemoptysis and weight loss increases the likelihood of bronchogenic lung cancer.

Objective research

The results of a physical examination help to establish the localization of the pathological process.

In patients with chronic cough, there are often no pathological abnormalities when examining the lungs.

Thus, large-caliber wet rales during inhalation and exhalation indicate damage to the trachea and large bronchi. Coarse, medium-bubble moist rales heard on inspiration may suggest interstitial fibrosis and/or interstitial pulmonary edema. Crepitation, on the contrary, indicates the filling of the alveoli of the lungs with fluid, for example, with pneumonia or pulmonary edema.

Moist rales in the lower portions of both lungs may indicate congestive heart failure or interstitial lung disease.

Widespread dry wheezing, especially during exhalation, is characteristic of bronchial asthma. However, we should not forget that in some patients with asthma, any auscultatory symptoms from the lungs may be absent.

Wheezing, which is heard over a limited area of the pulmonary field, makes one think about a partial obstruction of patency in one of the bronchi, as, for example, with endobronchial cancer or aspiration of a foreign body.

The examination of the cardiovascular system is aimed primarily at excluding valvular damage and congestive heart failure.

Enlargement of various groups of lymph nodes requires, first of all, the exclusion of neoplastic and lymphoproliferative diseases. Changes in the fingers of the hands in the form of “drumsticks” and fingernails “watch glass” can indicate a number of chronic lung diseases, including tuberculosis, cancer, abscess or widespread bronchiectasis.

Patients with chronic cough should consult an otolaryngologist. Examination of the ears should exclude the presence of foreign bodies, hair, or earwax accumulations in the external auditory canal. Examination of the nose and throat involves searching for possible causes of discharge down the back wall of the pharynx.

Laboratory and instrumental studies.

If a thorough history and objective examination allows you to determine the diagnosis, there is no need for further research.

If the doctor believes that further testing is appropriate, the next step is usually a chest x-ray.

During this study, they sometimes find:

A process involving the alveoli (pneumonic or non-pneumonic origin);
Porosity of any part of the lung tissue or cyst-like formation (local bronchiectasis);
Hilar lymphadenopathy (lymphogranulomatosis, sarcoidosis and other causes);
Intrapulmonary, central or peripheral space-occupying formation (tumor).

The absence of radiological changes allows one to narrow the diagnostic search, as well as reassure and reassure patients.

If asthma is suspected, the diagnosis can be confirmed using spirometry (performed before and after inhalation of an inhaled bronchodilator). To identify the presence of an obstructive pulmonary defect, the following pulmonary function tests are most often used:

Determination of forced expiratory volume in 1 second (FEV 1);
Peak expiratory flow;
Vital capacity of the lungs.

For productive cough, sputum microscopy and Gram staining of smears are performed. Microscopy of hematoxylin-eosin-stained sputum reveals signs of infection (pus) or allergy (eosinophils, Charcot crystals, Kurshman coils), as well as evidence of decay in the lungs (elastic fibers).

Gram staining and culture of sputum help clarify the bacterial or fungal nature of the disease, and cytological examination of sputum helps diagnose lung tumors. Due to the increasing incidence of tuberculosis, sputum is carefully examined for mycobacteria.

In patients with suspected sinusitis, radiography of the paranasal sinuses is performed.
The assumption of gastroesophageal reflux is verified using x-ray and endoscopic examination of the upper gastrointestinal tract and pH measurements in the esophagus.

With normal results of a chest x-ray, bronchoscopy can provide very little to determine the causes of chronic cough. This method should probably be reserved for patients:

Those presenting, in addition to cough, other complaints (for example, patients with hemoptysis;
Long-term smokers.
Over 50 years of age, especially in cases where less invasive methods do not recognize the causes of chronic cough.

Literature: Infections and antibiotics I. G. Bereznyakov. 2004 Kharkov.