Pradal M, Retornaz K, Poisson A
Service de Pneumologie, Hôpital Paul Desbief, Marseille, France.
Rev Mal Respir. 2004 Sep;21(4 Pt 1):743-62. doi: 10.1016/s0761-8425(04)71416-3.
Although less frequent than viral induced recurrent cough; chronic cough remains a sometimes difficult to resolve diagnostic tool.
Most authors estimate that a cough can by considered as chronic after three weeks of duration. Few papers have been published concerning etiologic diagnosis of chronic cough in childhood but these indicate the same main causes as in adults: cough variant asthma, postnasal drip syndrome, gastro-esophageal reflux. Nevertheless, each age bracket presents specific diagnosis: malformations between zero and one year, psychogenic cough in adolescents.
New techniques as induced sputum studies helps to refine chronic cough diagnosis in childhood (after 7 years). Eosinophilic bronchitis, associated or not to bronchial hyperresponsiveness has important therapeutic consequences because associated with a favourable response to corticosteroids. Other techniques will be developed in the future (exhaled NO for example).
Chronic cough in childhood must be investigated from an anatomic point of view and on frequency arguments. Control and removal of the cough will only be obtained if a precise diagnosis and a suitable treatment are reached.
尽管慢性咳嗽不如病毒引起的反复咳嗽常见,但它仍是一种有时难以解决的诊断手段。
大多数作者认为,咳嗽持续三周后可被视为慢性咳嗽。关于儿童慢性咳嗽病因诊断的论文较少,但这些论文表明其主要病因与成人相同:咳嗽变异性哮喘、鼻后滴漏综合征、胃食管反流。然而,每个年龄段都有特定的诊断情况:0至1岁的畸形,青少年的心理性咳嗽。
诱导痰研究等新技术有助于完善儿童期(7岁以后)慢性咳嗽的诊断。嗜酸性粒细胞性支气管炎,无论是否伴有支气管高反应性,都有重要的治疗意义,因为它对皮质类固醇有良好反应。未来还会开发其他技术(例如呼出一氧化氮)。
儿童慢性咳嗽必须从解剖学角度并依据发病频率进行调查。只有做出准确诊断并进行适当治疗,才能控制和消除咳嗽。