Why do my children always have bronchitis?

In the long-term clinical work, I found a problem. Many parents said that their children often suffer from bronchitis, and the effect of taking medicine is not good, and coughing for a long time. Asking about the condition in detail, I found that these children are not called "bronchitis", even if the chest radiograph report "bronchitis changes." Family members questioned why other doctors said it was bronchitis, and I said no, and did not need infusion therapy. The family members will be suspicious, and after taking the test and trying according to the method I have said, the cough has obviously improved, not even coughing. Today, I will answer the questions of my family members--why do my children always have bronchitis?

Why do my children always have bronchitis?

Everyone has a clear definition of what is called chronic cough. Medically defined chronic cough in children means that coughing lasts for more than 4 weeks. What are the causes of chronic cough? Which kind of cough does my child have? please watch the following part.

Chronic cough is roughly divided into two categories: one is a specific chronic cough; the other is a non-specific chronic cough. The so-called specific chronic cough means that chronic cough is a symptom associated with the more specific disease itself. For a simple example: patients with congenital tracheobronchial softening, whether adults or children, are accompanied by chronic cough, repeated wheezing, Expiratory dyspnea and pulmonary exhalation wheezing. This cough is caused by a malformation of the airway in the patient, which is a concomitant symptom of congenital tracheobronchial softening. If your child has no clear lung infection, pulmonary vascular disease, airway malformation, cardiovascular malformation, specific pulmonary hemosiderosis, etc., chronic cough is not specific. Chronic cough, but a non-specific chronic cough.


Non-specific chronic cough is actually the focus of this article. It refers to chronic cough with cough as the main or only symptom and no special changes in chest radiograph. It is the most common type of chronic cough in clinical practice. These include many diseases with obvious age characteristics. The following is a brief explanation of the common clinical non-specific chronic cough.

Age stage

Common causes of chronic cough

Infancy

<1 year old

Respiratory infection and cough after infection, congenital tracheal-pulmonary dysplasia, gastroesophageal reflux, tuberculosis, other congenital cardiothoracic abnormalities

Early childhood

1-3 years old

Respiratory infection and post-infection cough, upper airway cough syndrome, cough variant asthma, airway foreign body, gastroesophageal reflux, tuberculosis

Preschool age

3-6 years old

With the cause of early childhood, in addition to bronchiectasis, etc.

School age - adolescence

Upper airway cough syndrome, cough variant asthma, post-infection cough, tuberculosis, psychogenic cough, airway foreign body, bronchiectasis

(1) Acute respiratory infection and post-infection cough (PIC): After an acute respiratory infection, the symptoms of cough are more than 4 weeks, and PIC can be considered. If you want to diagnose PIC, doctors should pay attention to the following questions:

• A recent history of respiratory infections;
• Cough is irritating dry cough or with a small amount of white sticky;
• There is no abnormality in chest X-ray examination;
• Normal lung ventilation function;
• Cough is usually self-limiting; except for other causes of chronic cough. If the coughing time exceeds 8 weeks, other diagnoses should be considered.

(2) Cough variant asthma (CVA): CVA is one of the common causes of chronic cough in children, especially preschool and school age children. If you want to diagnose CVA, doctors should pay attention to the following questions:

• Persistent cough for > 4 weeks, often at night and / or early morning attacks, exercise, cold cough after the cold, clinical signs of no infection or long-term antibiotic treatment is invalid;
• Diagnostic treatment of bronchodilator can significantly relieve the symptoms of cough;
• The pulmonary ventilation function is normal, and the bronchial provocation test indicates high airway reactivity;
• History of allergic diseases including history of drug allergy, and positive family history of allergic diseases. Positive detection of allergens can aid diagnosis;
• Excluding chronic cough caused by other diseases.

(3) Upper airway cough syndrome (UACS): all kinds of rhinitis (allergic and non-allergic), sinusitis, chronic pharyngitis, chronic tonsillitis, nasal polyps, adenoid hypertrophy and other upper airway diseases can cause chronic Cough, previously diagnosed as postnasal drip (flow) syndrome (PNDs), meaning cough caused by nasal secretions flowing back to the pharynx through the posterior nasal orifice. If you want to diagnose UACS, doctors should pay attention to the following questions:

• Chronic cough with or without cough, cough is often changed in the morning or body position, often accompanied by nasal congestion, runny nose, dry throat and foreign body sensation, repeated clearing, and adhesion to the mucous membrane of the posterior pharyngeal wall. The child complained of headache, dizziness, low fever, etc.
• Examination of the sinus area may have tenderness. The sinus opening may have a yellow-white secretion, and the follicles on the posterior pharyngeal wall are obviously proliferated, showing a cobblestone-like appearance, and sometimes the mucus-like substance in the posterior pharyngeal wall is attached;
• Targeted treatments such as antihistamines (such as loratadine) and leukotriene receptor antagonists (such as Shun Ning), nasal glucocorticoids (such as Nesanna) and other effective;
• Caused by sinusitis, the sinus x-ray film or CT film can be seen corresponding changes.

(4) Gastroesophageal reflux cough (GERC): Gastroesophageal reflux (GER) is a physiological phenomenon in infants and young children. The incidence of GER in healthy infants is 40-65%, peaking in 1 to 4 months, and naturally relieved at 1 year of age. When it causes symptoms and/or is accompanied by gastroesophageal dysfunction, it becomes a disease called gastroesophageal reflux disease (GERD). There is no definitive evidence that GER is a common cause of chronic cough in children in China. If you want to diagnose GERC, doctors should pay attention to the following questions:

• Relatively infancy, paroxysmal cough, sometimes cough, mostly occurs at night;
• Most of the symptoms appear after eating and feeding is difficult. Some children are accompanied by upper abdominal or xiphoid discomfort, post-sternal burning, chest pain, sore throat, etc.
• In addition to causing cough, infants may also cause asphyxia, bradycardia and arching of the back;
• Can lead to stagnant or delayed growth and development of the child.

(5) Eosinophilic bronchitis (EB): The incidence of AIDS in children is not clear. I have not yet diagnosed EB patients. The clinical features and diagnostic clues of EB are:

• Chronic irritating cough;
• Chest X-ray film is normal;
• Normal pulmonary ventilation, no airway hyperresponsiveness;
• The relative percentage of eosinophils in sputum is >3%;
• Oral or inhaled corticosteroids are effective.

(6) Cardiac cough: Cardiac cough can only be diagnosed except for tic disorder, and cough can be improved after behavioral intervention or psychotherapy; cough characteristics have only a suggestive effect on psychogenic cough, and have no diagnostic effect.

• More common in older children;
• Daily coughing, focusing on something or coughing at night;
• Often accompanied by anxiety symptoms;
• There are no organic diseases, and other causes of chronic cough are excluded.

(7) Tracheal foreign body: Cough is the most common symptom of airway foreign body inhalation. Foreign body inhalation is an important cause of chronic cough in children, especially children aged 1-3. The study found that 70% of patients with airway foreign body inhalation showed cough, and other symptoms include respiratory sound reduction, wheezing, and history of asphyxia. Cough usually manifests as paroxysmal severe cough, or can only be manifested as chronic cough with obstructive emphysema or atelectasis. Once foreign body enters the area below the small bronchi, there is no cough.

(8) Otogenic cough: 2-4% of the population has vagus nerve branches (arnold nerves). In this part of the population, when the middle ear has a lesion, the vagus nerve is stimulated to cause a chronic cough. Otogenic cough is a rare cause of chronic cough in children. (PS. I cough when I rub my ears, my father too.)

Now "bronchitis" is like a trash can, a lot of unclear cough, diagnosed with bronchitis first, according to the conventional anti-infective, anti-cough symptomatic treatment after treatment. So repeatedly toss, so caused by the opening, many family members said that children often suffer from bronchitis. In fact, bronchitis is also strictly defined. The radiology section on bronchial inflammation mainly refers to the thickening, disorder, and reticular or cord-like texture of the lungs. The radiology report of the radiology department often indicates "(mild) bronchial inflammatory changes". Our doctors must read the re-reading chest X-ray. The auxiliary examination must be combined with clinical practice. Many times it is not bronchitis, and family members do not think that the chest radiograph is reported. It is bronchitis that is bronchitis.