Beruflich Dokumente
Kultur Dokumente
Alvin Sinaga
Outline
• Introduction • Diagnosis
• Definition • Treatment
• Classification • Complication
• Epidemiology • Prevention
• Pathophysiology • Take home
• Etiology message
Introduction
• Cough is the most common presenting
symptom to GP and most common referal
to Pediatrician & Respiratory physician.
• Cough in children causes Significant
anxiety to parent. And affect quality of
life.
Definition
Chronic cough:
• Adult: cough ≥ 8 weeks (ATS, BTS)
• Pediatric: cough ≥ 8 weeks (BTS)
≥ 4 weeks (ATS)
BMJ (2008)
Classification
3. On cough quality:
• Barking or brassy
• Honking
• Paroxysmal
• Staccato
• Productive cough
• Chronic wet cough in the morning only
Erj.e rsjournals.com
… epidemiology
• The prevalence
▫ 22% of preschool children w/o cold.
▫ 50% in children with two smoking parent.
▫ Higher in dump home, poluted area and
low sosio-economic status.
▫ Chronic cough is associated with high
morbidity and mortality.
http://www.dietoflife.com/cure-your-cough-or-inflammation-of-the-lungs-with-this-quick-trick/
… pathophysiology
Human cough reglex
UACS
• CVA (31,8%)
• UACS (37,6%) Post viral
cough
• Post viral cough (18,8%) GER
• GER (3,5%)
Allergic
• Allergic cough (2,4%) cough
• Unknown (5,9%) Unknown
Common etiologies of chronic cough based
on child age
Young children (<5 years) Older children (>5 years)
• Infections • Asthma
• Gastroesophageal reflux • Infection
• Congenital malformation
• Post-nasal drip
• Asthma
• Protracted bacterial
• Protracted bacterial
bronchitis
bronchitis
• Passive smoking & • Passive smoking
environmental pollution • Bronchiectasis
• Foreign body inhalation • Psychogenic cough
https://www.sciencedirect.com/science/article/pii/S2352646715000344
Etiology of Chronic Cough
Recurrent respiratory tract infection
Post viral infection
Protracted bacterial bronchitis
Gastroesophageal reflux
Laryngopharyngeal reflux
Asthma
Upper airway cough syndrome
http://wallsviews.co/asthma-dry-cough-chest-pain/
Asthma
Diagnosis:
• History of respiratory symptom such as
wheeze, shortness of breath chest
tightness & cough that very over time.
• Variable expiratory airflow
Therapy:
• Bronchodilator
• ICS
• LRTA
Post Infectious cough
Common pathogen
• Viral RSV, Parainfluenza Virus
• M-pneumoniae, C-pneumoniae,
B-pertussis
Result of airway inflammation
CXR: (N)
Therapy : Macrolide for Bacterial
ICS
Inhaled Ipratropium
Cough suppressant ≥ 4 y/o
GER / Gastroesophageal Reflux
• The respiratory manifestation: cough,
wheezing, sore throat, hoarseness, throat
clearing, choking and throat irritation.
• Therapy : PPI
▫ H2 blocker
▫ Laparoscopic fundoplication
▫ Life style and Diet therapy
Cough and Allergic diseases
Allergic cough has certain characteristics
that are common to all allergic diseases
such as
Presence of a family history of allergy
History of past and/or concomitant
allergic conditions (such as
urticaria, eczema)
Sensitivity to allergens that can be
elicited by skin testing
Therapeutic response to epinephrine
Periodic nature of the allergic condition.
Indian Journal of Clinical Practice, Vol. 24, No. 11, April 2014
Treatment
Allergic Rhinitis
• Nasal Corticosteroid
• Antihistamine
• Nasal Decongestant
• Ipratropium Nasal Spray
Asthma:
• Bronchodilator
• Corticosteroid
• Antihistamine
GERD:
• PPI
• Diet therapy
• Life style
Bronchiolitis
• Low dose macrolide
…treatment
Chronic bronchitis
• Mucus active agent
• Inhaled SABA/LABA
• Theophylline
• Codein (in adult)
History
• FHx of lung disease
• Neonatal onset
• Sudden onset
• Haemoptysis
• Cough with feeding, dysphasia, severe
Vomiting
• Chronic moist cough with sputum
• Night sweat / Weight loss
• Continues unremitting or worsening cough
Sign:
• Sign of CLD
• FTT
• Abnormal Voice
• Focal chest abnormality
• Bronchospasm
• Rib fracture
• Air leak
(pneumomediastinum)
or pneumothorax
• Syncope
• Vomiting FTT
Prevention
• Unpreventable:
▫ Genetic
• Preventable:
▫ Environment
Allergen
Pollutant
Take home message
• Chronic cough in children is different from adult.
• The Etiology of cough is different in each country,
region and continental.
• Pathophysiology must be understood to understand
the occurrence of chronic cough
• The Treatment based on etiology.
• Bronchodilator , ICS, anti histamine are drug that
are often used in the treatment of chronic cough.
• In cased of referral Patient, Chest X-Ray, Sinus CT-
Scan, Allergy Test & Bronchoscope are required to
confirm diagnosis.
• Good treatment can avoid complication.
• Avoidance of environmental factor can prevent
chronic coughing.
•
THANK YOU