Fifteen-minute consultation: A structured approach to the management of chronic cough in a child

Author(s):  
Cherry Alviani ◽  
Gary Ruiz ◽  
Atul Gupta

Coughing is a primary pulmonary defence mechanism that enhances clearance of secretions and particles from the airways and protects against aspiration of foreign materials. Coughing may affect 30% of children at any given time (1). Many are healthy children but some may have serious underlying disease. Childhood cough accounts for a large number of consultations and 80% of families who are referred to a paediatric respiratory clinic for chronic cough have sought medical advice five times or more (2). The majority of childhood coughs are secondary to an acute respiratory tract infection and will improve once the infection resolves, usually within 1 to 3 weeks. With pre-school children who may experience between 6 and 10 respiratory infections a year differentiating acute recurrent cough from chronic cough is key (Table 1). Chronic cough can significantly impact a family’s quality of life, as it affects the child’s sleep, school attendance and play. Parents experience distress and anxiety, worrying that the cough may lead to long-term chest damage or even death (3). This article aims to guide clinicians through the assessment of the child with a chronic cough. It will discuss identifying causes, use of first line investigations, initiating appropriate management and addressing parental anxiety and exacerbating factors (4,5).

2021 ◽  
Vol 30 (162) ◽  
pp. 210127
Author(s):  
Alyn Morice ◽  
Peter Dicpinigaitis ◽  
Lorcan McGarvey ◽  
Surinder S. Birring

Chronic cough is defined in adults as a cough that lasts for ≥8 weeks. When it proves intractable to standard-of-care treatment, it can be referred to as refractory chronic cough (RCC). Chronic cough is now understood to be a condition of neural dysregulation. Chronic cough and RCC result in a serious, often unrecognized, disease burden, which forms the focus of the current review.The estimated global prevalence of chronic cough is 2–18%. Patients with chronic cough and RCC report many physical and psychological effects, which impair their quality of life. Chronic cough also has a significant economic burden for the patient and healthcare systems. RCC diagnosis and treatment are often delayed for many years as potential treatable triggers must be excluded first and a stepwise empirical therapeutic regimen is recommended.Evidence supporting most currently recommended treatments is limited. Many treatments do not address the underlying pathology, are used off-label, have limited efficacy and produce significant side-effects. There is therefore a significant unmet need for alternative therapies for RCC that target the underlying disease mechanisms. Early clinical data suggest that antagonists of the purinergic P2X3 receptor, an important mediator of RCC, are promising, though more evidence is needed.


2017 ◽  
Vol 103 (2) ◽  
pp. 137-142 ◽  
Author(s):  
Krista Keilty ◽  
Eyal Cohen ◽  
Karen Spalding ◽  
Eleanor Pullenayegum ◽  
Robyn Stremler

ObjectivesFamily caregivers of children who depend on medical technology (CMT) provide highly skilled care up to 24 hours per day. Sleep disruption places family caregivers at risk for poor health and related outcomes that threaten their long-term caregiving capacity. Few studies exist that have measured sleep in family caregivers, and most have relied entirely on subjective measures.MethodsIn a prospective cohort study, family caregivers of CMT (n=42) and caregivers of healthy children (n=43) were recruited. Actigraphy data and a concurrent sleep diary were collected for 6 days/7 nights. Measures of sleep quality, depression, sleepiness, fatigue and quality of life were also administered.ResultsFamily caregivers of CMT averaged fewer hours of sleep per night (mean (SD)) (6.56 ± 1.4 vs 7.21 ± 0.6, p=0.02) of poorer quality (7.75 ± 2.9 vs 5.45 ± 2.8, p<0.01) than the control group. Three times as many family caregivers of CMT scored in the range for significant depressive symptomatology (12(33%) vs 4(10%), p=0.01) and experienced excessive daytime sleepiness (16(38%) vs 5(12%), p<0.01). Fatigue was also more problematic among family caregivers of CMT (22.12 ± 9.1 vs 17.44 ± 9.0, p=0.02).ConclusionsFamily caregivers of CMT are at risk of acute and chronic sleep deprivation, psychological distress and impaired daytime function that may threaten their capacity for sustained caregiving. Family caregivers of CMT may be important targets for screening for sleep disorders and the development of novel sleep-promoting interventions.


2020 ◽  
pp. 124-131
Author(s):  
N. V. Orlova

Cough is one of the most common symptoms and is present in diseases of the respiratory, cardiovascular, digestive, endocrine and other systems. Cough is a reflex act, therefore it is caused by stimulation of cough receptors due to pathological influences. The diagnosis takes into account the nature of the cough, its duration, the results of laboratory and instrumental examination methods. The most attention is required to diagnose chronic cough and exclude life-threatening causes. Symptoms of anxiety are hemoptysis, prolonged resistant cough, prolonged intoxication syndrome, weight loss, etc. In diagnostically unclear cases, the examination schedule must include computed tomography of the chest, magnetic resonance imaging and bronchoscopy. A dry, painful intense cough can lead to the development of complications: a decrease in the quality of life, hemorrhages, pneumothorax, etc., therefore, requires symptomatic treatment. A common cause of unproductive cough is viral diseases, whooping cough, diseases leading to overactive cough receptors. The variety of coughs determines a differentiated approach to its therapy. The main efforts should be directed to the treatment of the underlying disease. In the case of a productive cough, mucoactive drugs are used. To stop unproductive cough, antitussive drugs of central and peripheral action are used. The recommendations of the European Respiratory Society present the results of clinical trials assessing the efficacy and safety of antitussive drugs with morphine-like action. The study identified side effects that limit their use. One of the most effective and safe drugs is a non-opioid drug with a central action Sinekod. The effectiveness and safety of the drug is confirmed by clinical studies.


Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 5163-5163
Author(s):  
Takao Yoshihara ◽  
Akira Morimoto ◽  
Hiroshi Kuroda ◽  
Hiroyuki Ishida ◽  
Toshihiko Imamura ◽  
...  

Abstract The long-term presence of fetal hematopoietic cells in the maternal blood after childbirth indicates maternal tolerance to fetal inherited paternal antigens (IPA), and also that of maternal hematopoietic cells in the offspring’s blood after birth indicates mutual tolerance to non-inherited maternal antigens (NIMA) among sibling. Based on such recent feto-maternal microchimerism / tolerance theory, more than 40 cases have received non-T-cell-depleted (non-TCD) HLA-haploidentical stem cell transplantation (SCT) for various hematological malignancies in Japan. Their early post-SCT clinical courses have been reported; however, long-term outcome and quality of life of such SCT recipients are largely unknown. In our hospitals, we used non-TCD cells from haploidentical family donors for transplantation in 5 children with hematologic malignancies. Among those children, four have been alive for more than one year. Three of the 4 recipients still require prophylactic immunosuppressants for chronic GVHD. Only one case developed chronic GVHD (skin limited). Various late complications are noted in 3. Three children showed complete school attendance. Two of the three are also allowed to participate in physical exercises. These results suggest that quality of life in long-term survivors in childhood from non-TCD HLA-haploidentical SCT based on feto-maternal microchimerism seems acceptable although the numbers are still small and the follow-up period is short. Patients characteristics Case Age Diagnosis Status Donor HLA mismatch acute GVHD Survival after SCT (days) 1 6 ALL CR1 (advanced remission) NIMA-mismatched sibling 2 2 CR, 802+ 2 11 ALL Rejection after UCBT (CR2) Mother 2 1 CR, 775+ 3 16 MLL Refractory relapse after UCBT Mother 2 1 CR, 519+ 4 14 CML Blastic phase Mother 2 1 CR, 473+ 5 6 ALL Rejection after UCBT (Rel 1) Mother 3 2 Dead, 93 Present status of long-term survivors Case chronic GVHD Karnofsky score Late complications School attendance Physical exercise Medication 1 - 100 - complete permitted - 2 - 100 hypothyroidism complete permitted FK506 3 + (skin) 70 diabetes, esophageal stricture no prohibited PSL+MTX, insulin 4 - 100 arrhythmia complete prohibited FK506


BMJ Open ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. e040990
Author(s):  
Peter von Philipsborn ◽  
Renke Biallas ◽  
Jacob Burns ◽  
Simon Drees ◽  
Karin Geffert ◽  
...  

ObjectivesTo assess the effects of non-steroidal anti-inflammatory drugs (NSAIDs) in patients with viral respiratory infections on acute severe adverse outcomes, healthcare utilisation, quality of life and long-term survival.DesignRapid systematic review.ParticipantsHumans with viral respiratory infections, exposed to systemic NSAIDs.Primary outcomesAcute severe adverse outcomes, healthcare utilisation, quality of life and long-term survival.ResultsWe screened 10 999 titles and abstracts and 738 full texts, including 87 studies. No studies addressed COVID-19, Severe Acute Respiratory Syndrome or Middle East Respiratory Syndrome; none examined inpatient healthcare utilisation, quality of life or long-term survival. Effects of NSAIDs on mortality and cardiovascular events in adults with viral respiratory infections are unclear (three observational studies; very low certainty). Children with empyema and gastrointestinal bleeding may be more likely to have taken NSAIDs than children without these conditions (two observational studies; very low certainty). In patients aged 3 years and older with acute respiratory infections, ibuprofen is associated with a higher rate of reconsultations with general practitioners than paracetamol (one randomised controlled trial (RCT); low certainty). The difference in death from all causes and hospitalisation for renal failure and anaphylaxis between children with fever receiving ibuprofen versus paracetamol is likely to be less than 1 per 10 000 (1 RCT; moderate/high certainty). Twenty-eight studies in adults and 42 studies in children report adverse event counts. Most report that no severe adverse events occurred. Due to methodological limitations of adverse event counts, this evidence should be interpreted with caution.ConclusionsIt is unclear whether the use of NSAIDs increases the risk of severe adverse outcomes in patients with viral respiratory infections. This absence of evidence should not be interpreted as evidence for the absence of such risk. This is a rapid review with a number of limitations.PROSPERO registration numberCRD42020176056.


2020 ◽  
Vol 22 (9) ◽  
pp. 1379-1387 ◽  
Author(s):  
Bree R Eaton ◽  
Saveli Goldberg ◽  
Nancy J Tarbell ◽  
Miranda P Lawell ◽  
Sara L Gallotto ◽  
...  

Abstract Background The purpose of this analysis is to report long-term health-related quality of life (HRQoL) among brain tumor survivors treated with proton therapy (PRT) at a very young age. Methods Fifty-nine children &lt;4 years old received PRT between 2000 and 2011. Forty families participated. HRQoL was assessed by child self-report (CSR; age ≥5) and parent proxy report (PPR; age 2+) using the PedsQL Core. Results The median age was 2.5 years (range, 0.3–3.8) at PRT and 9.1 years (5.5–18) at last follow-up. The most common diagnoses were ependymoma (n = 22) and medulloblastoma (n = 7). Median follow-up is 6.7 years (3–15.4). Follow-up mean CSR and PPR scores were: total core (78.4 and 72.9), physical (82.9 and 75.2), psychosocial (76.0 and 71.6), emotional (74.4 and 70.7), social (81.2 and 75.1), and school (72.4 and 69.9). Parent-reported HRQoL fell within a previously defined range for healthy children in 37.5% of patients, and for children with severe health conditions in 45% of patients. PPR HRQoL was stable from baseline to last follow-up among all domains except for social functioning. History of gastrostomy tube was significantly associated with poorer CSR and PPR HRQoL on multivariable analysis. Ninety percent of children functioned in a regular classroom, 14 (36%) used a classroom aid, 9 (23%) used an outside tutor, and 18 (46%) had an individualized education plan. Conclusion Long-term HRQoL among brain tumor survivors treated with PRT at a very young age is variable, with over a third achieving HRQoL levels commensurate with healthy children. Key Points 1. One third of survivors reported long-term HRQoL scores comparable to those of healthy children. 2. Treatment for hydrocephalus or a feeding tube was associated with significantly lower HRQoL. 3. Total core HRQoL scores remained stable from baseline to last follow-up.


2012 ◽  
Vol 48 (No. 7) ◽  
pp. 183-189 ◽  
Author(s):  
V. Vecerek ◽  
A. Kozak ◽  
M. Malena ◽  
B. Tremlova ◽  
P. Chloupek

The results of veterinary meat inspection classification of 4&nbsp;000&nbsp;372 bovine carcasses reflect long-term aspects of health status in cattle herds and the quality of transport and handling of animals at slaughterhouses. Veterinary inspectors recorded the data obtained from meat inspection classification of bovine carcasses at slaughterhouses in the CzechRepublicduring the period of 1995&ndash;2002 together with the reasons for classification. The trends were evaluated by a comparison of two periods (Period I, 1995&ndash;1998, and Period II, 1999&ndash;2002) by means of calculating the indexes of values from Period II compared to those of Period I. Bovine carcasses classified as capable for human consumption (edible) were found in 87.87% of cases (88.83% during Period I and 86.58% during Period&nbsp;II, index 0.97), while those classified as capable for processing (conditionally edible) were found in 7.53% of cases (7.38% during Period I and 7.71% during Period II, index 1.04), and those condemned in 4.60% of cases (3.79% during Period I and 5.71% during Period II, index 1.51). The most important reason for classifying the carcasses as condemned was the finding of sensorial changes in meat, which occurred in 2.56% of cases (2.23% during Period I and 3.00% during Period II, index 1.35), followed by lesions due to non-infectious diseases &ndash; 1.00% (0.81% during Period I and 1.25% during Period II, index 1.53), added deleterious substances &ndash; 0.88% (0.60% during Period I and 1.27% during Period II, index 2.11), lesions due to respiratory infections &ndash; 0.03% (0.02% during Period I and 0.04% during Period II, index 1.74), and lesions due to miscellaneous infectious diseases &ndash; 0.10% (0.10% during Period I and 0.10% during Period II, index 1.05). Other reasons to condemn the carcasses included improper identification, lesions due to digestive infections, lesions due to tuberculosis, lesions due to paratuberculosis, lesions due to salmonellosis, leucosis and parasitic diseases. The occurrence of these conditions was on the level of mere hundredths of per cent. According to the results of meat inspection classification, the risk of food-borne diseases originating from bovine carcasses tends to be greater in the lesions due to non-infectious conditions with a long-term increasing trend. A&nbsp;considerable increase in the numbers of bovine carcasses condemned because of lesions due to paratuberculosis (index 4.62) represents an alarming finding with regard to potential food safety hazards.


2020 ◽  
Vol 24 (3) ◽  
Author(s):  
Dariusz Góra ◽  
Natalia Figura ◽  
Marcin Gregor

Introduction. Health condition is one of the basic factors determining the quality of life of children and adolescents. Childhood ill health is especially dangerous as it can interfere with developmental processes and lead to long-term and permanent health problems. Health problems that cause hospitalization are mainly childhood diseases, which, due to the course or accompanying complications, require hospital treatment. The most common reasons for hospitalizing children and adolescents in children are respiratory infections, cardiovascular diseases, cancer, and mental diseases. Aim. The aim of the article is to present the most frequent hospitalizations of children and adolescents from various cities of the Silesian Voivodeship in 2010-2018. Material and methods. The research material is data from the Silesian Voivodeship Office in Katowice – Department of Health. Results. The hospitalization rate for bronchial asthma is increasing in Bielsko-Biała and Sosnowiec. In Bielsko-Biała, Katowice, Sosnowiec and Zabrze, the number of children hospitalized due to mental disorders is increasing. Conclusions. Hospitalization due to neoplastic diseases is variable in all the discussed cities of the Silesian Voivodeship. One of the basic elements of health policy is having knowledge about the health condition of the population of children and adolescents and its wider health needs. Analyzes of the frequency and causes of hospitalization of children and adolescents can be a source of information on factors influencing the health of children and adolescents.


2012 ◽  
Vol 48 (No. 8) ◽  
pp. 207-214 ◽  
Author(s):  
A. Kozak ◽  
V. Vecerek ◽  
P. Chloupek ◽  
B. Tremlova ◽  
M. Malena

The results of meat inspection classification of pig carcasses reflect long-term aspects of health status in pig production farms and the quality of transport and handling of animals at slaughterhouses. Veterinary inspec&shy;tors recorded the data obtained from meat inspection classification of 36 028 821 pig carcasses at slaughterhouses in theCzechRepublicduring the period of 1995&ndash;2002 together with the reasons for classification. The trends were evaluated by a comparison of two periods (Period I: 1995&ndash;1998; Period II: 1999&ndash;2002) by means of calculating the indexes of values from Period II compared to those of Period I. Pig carcasses classified as capable for human con&shy;sumption (edible) were found in 97.28% of cases (97.26% during Period I and 97.31% during Period II, index 1.00), while those classified as capable for processing (conditionally edible) were found in 2.15% of cases (2.28% during Period I and 2.02% during Period II, index 0.89), and those condemned in 0.57% of cases (0.47% during Period I and 0.67% during Period II, index 1.43). The reasons for classifying the carcasses as condemned were as follows: sensorial changes in meat &ndash; 0.33% (0.26% during Period I and 0.41% during Period II, index 1.56), lesions due to non-infec&shy;tious diseases &ndash; 0.12% (0.12% during Period I and 0.12% during Period II, index 0.97), added deleterious substances &ndash; 0.05% (0.03% during Period I and 0.07% during Period II, index 2.50), lesions due to respiratory infections &ndash; 0.03% (0.03% during Period I and 0.04% during Period II, index 1.70), boar taint &ndash; 0.02% (0.02% during Period I and 0.03% during Period II, index 1.36). Other reasons to condemn the carcasses included tuberculous lesions, lesions due to miscellaneous infections, digestive infections, parasitic diseases, and Salmonella infections. The occurrence of these conditions was on the level of mere hundredths of per cent. No case of Aujeszky&rsquo;s disease was found. According to the results of meat inspection classification, the risk of food-borne diseases originating from pig carcasses tends to be greater in the lesions due to non-infectious conditions with a long-term increasing trend. A considerable increase in the numbers of pig carcasses condemned due to added deleterious substances (index 2.50) is an alarming finding with regard to potential food safety hazards.


2021 ◽  
Vol 17 (2) ◽  
pp. 57-61
Author(s):  
Ol'ga Uspenskaya ◽  
Saniya Spiridonova

Introduction. Psychological comfort is one of the most important components in the formation of a healthy, full-fledged personality. The requirements of patients to the dentist are not only not limited to the treatment of the underlying disease and the successful restoration of lost functions, but also include the achievement of a good aesthetic effect — patients highly appreciate a beautiful, relief and at the same time smooth restoration. Thus, the relevance of dental restoration is acquiring not only medical significance, but also social connotation. The aim of the work was to carry out a comparative assessment of the quality of the composite restoration using polishing pastes of various abrasiveness. Material and methods. The study involved 60 patients of both sexes, aged 18-43 years, who underwent aesthetic restoration in the area of the anterior group of teeth of 4 and 5 classes according to Black's classification using the light-curing composite material Enamel plus HRi UD5. The observation was carried out in the immediate and long-term periods (12 months after the end of treatment). For finishing the restorations, we used Cleanic, Flairesse, Clean Polish and Enamel Shinec polishing pastes with different RDA indices. The patients were divided into 4 groups depending on the polishing paste used. Results and its discussion. As a result of the study, it was revealed that the RDA index of polishing pastes plays an important role in finishing, exerting great importance on the smoothness of the restoration, "dry shine" and allows to achieve better marginal adaptation of the material and better color fastness of the restoration. Conclusions. Thus, our study revealed the best result in the paste with the maximum value of RDA (83) — Flaresse (DMG).


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