It is time to spring and winter, the outpatient department of respiration patients began to increase, and many of these patients is affected
It is time to spring and winter, the outpatient department of respiration patients began to increase, and many of these patients is affected by repeated cough and distress to the hospital.
Ask a question first, is cough a disease? In fact, cough is a symptom of many diseases, including respiratory diseases and other diseases of the system. So, exactly speaking, the name "cough" is not a disease, it is actually a reflection of a defense mechanism of human respiratory protection, in order to help a clear reflection of respiratory secretions. In respiratory stimulation, a physiological reflex cough caused by central afferent impulses, can discharge respiratory secretions or protect the respiratory tract foreign body, clean and smooth, therefore, cough is a kind of reflex action, protective reflex is necessary for the human body health. In general, the mild without frequent cough, sputum or as long as the foreign body eduction, can relieve nature. However, if it is frequent and severe cough, it will bring trouble to people, affect the rest and sleep, increase physical exertion, causing serious impact on work and life.
Outpatient often encounter patients, cough for a long time, do not think it is a serious problem. To go to the pharmacy to buy a variety of cough medicine, home some anti-inflammatory drugs, can eat also eat a lot of cough seemed better, it seems not good, over and over again. Sometimes also used the earth, loquat leaf stewed radish juice, honey boiled eggs, a variety of, but it is not good. Really can not stand the cough, sometimes is home to the people he coughed stand, will think of home follow-up to the doctor, some patients in the treatment time will require additional hang brine, many also specified the use of penicillin. This is what we often encounter in the clinic. Therefore, cough, how to treat, do not need to hang brine, is not to use antibiotics, in fact, it still needs to further clarify the diagnosis, according to a variety of reasons to reasonable treatment.
Let's divide the cough. In general, we divided cough into 3 categories: acute cough, subacute cough and chronic cough. Acute cough time 3 weeks, subacute cough for 3 to 8 weeks, chronic cough for 8 weeks. The etiology of chronic cough, can according to the chest X-ray examination is divided into two categories: one for the chest X-ray have clear lesions, such as pneumonia, tuberculosis, lung cancer and so on; the other is chest X-ray showed no abnormalities, cough or only symptoms, is clinically common unexplained chronic cough (chronic cough).
The patient on the clinic to see a cough, the doctor will first round around the situation of cough ask some history. According to the duration of cough can determine acute, subacute or chronic cough, narrowing the scope of diagnosis.
The etiology of acute cough is relatively simple, common cold, acute bronchitis is the most common disease of acute cough. The common cold clinical manifestations of nasal symptoms, such as sneezing, runny nose, stuffy nose and nasal drops after influenza, throat irritation or discomfort, with or without fever. The common cold cough is often related to the nasal drip and throat irritation. Treatment is generally symptomatic treatment, often do not need to use antibacterial drugs. Containing pseudoephedrine hydrochloride and reduce the role of anti histamine drugs containing mucosal congestion, reduce the secretion of the gland, the clinical commonly used compound preparation of these drugs, pseudoephedrine therapy and choice of first generation antihistamines can help relieve nasal congestion, sneezing and other symptoms. For example: Tylenol, contacnt etc.. If the cough is more serious, the drug can also use some heat cough and phlegm, can use cough medicine.
Acute bronchitis is an acute inflammation of the tracheobronchial mucosa caused by various factors. Viral infection is the most common cause of bacterial infection. Cold air, dust and irritant gas can also cause or aggravate the disease. These two days of cold weather changes, air quality may not be very good, respiratory cough patients on the increase, a lot of it is due to acute bronchitis. Clinical manifestations of early onset often have upper respiratory tract infection symptoms. Then cough gradually intensified, with or without sputum, with bacterial infections often cough purulent sputum. Acute bronchial are usually self limiting, systemic symptoms may disappear in a few days, but the cough usually lasts for 2 to 3 weeks. X-ray examination showed no abnormalities or only increased lung markings. Check the lungs are rough, sometimes can hear the wet or dry rales. The principle of treatment is symptomatic treatment. Severe dry cough may be used antitussive, cough and expectorant cough medicine is not easy when available. If there is a bacterial infection, such as purulent sputum or peripheral white blood cells increased, may be appropriate to choose some antibacterial drugs. Bronchodilator therapy for bronchial spasm. Also note that smoking cessation. The clinic often encountered such a patient, but to see a cough, but his mouth coughed up a strong smell of smoke. People who smoke are less able to defend and repair the bronchial mucosa, and are more pronounced in acute airway inflammation, which can lead to a more severe cough.
Subacute cough is the most common cause of cough after infection. When the acute respiratory tract infection symptoms, cough still delayed healing. In addition to respiratory viruses, other pathogens such as bacteria, mycoplasma and Chlamydia are likely to cause infection after coughing, which is caused by a cold cough is the most common, also known as "cold cough". This kind of cough was irritating cough or cough with a small amount of white mucus sputum, usually lasts for 3 to 8 weeks, X-ray examination showed no abnormal. In dealing with this situation, first of all, to determine whether the cough is secondary to the original cold symptoms of the respiratory tract, and empirical treatment. Treatment is invalid, and then consider other causes and refer to the diagnosis and treatment of chronic cough program.
After infection, cough is self limiting and can relieve itself. Usually do not need to use antibiotics, but for Mycoplasma pneumoniae, chlamydia and other infections caused by cough, the use of macrolide antibiotics. On the part of cough obvious symptoms may be short-term application of antitussive, anti histamine drugs and decongestants etc..
The common causes of chronic cough include: cough variant asthma (CVA), upper airway cough syndrome, eosinophilic bronchitis and gastroesophageal reflux induced cough, the etiology in etiology of chronic cough in respiratory medicine clinic from 70% to 95%. Most chronic cough has nothing to do with infection, and no need to use antibiotics.
Cough variant asthma is a special type of asthma, wheezing, chest tightness, no obvious symptoms such as shortness of breath, cough is the only or the main clinical manifestations. More irritating cough, cough is usually more intense, nocturnal cough is one of the most important features. Cold, cold air, dust, fumes, as well as a variety of allergens, such as easy to induce or aggravate coughing. Last month, I saw a patient in the outpatient clinic. I had a cough for more than 3 months. I had a bad cough. In other places before using a lot of antibiotics and a variety of cough medicine, the effect is not good. I took the chest, not what problem, a blood test, found that the eosinophil is a little high, prompting her cough associated with allergy. So I went on to ask her out, she recently raised a pet dog, just also raised more than 3 months. I gave her a lung function that confirmed a small airway obstruction. At my suggestion of her pet dog give someone a dog, I gave her with inhaled corticosteroids and bronchodilators, before going to bed plus a grain of leukotriene receptor antagonist, montelukast, the effect is very good, a week later, the cough is obviously better.
Upper airway cough syndrome, past known as postnasal drip syndrome, is the image of the name of nasal disease caused by nasal and throat secretions reflux after the other parts, directly or indirectly stimulate cough receptors, leading to cough syndrome as the main manifestation. In addition to nasal disease, UACS is often associated with throat diseases, such as acute pharyngitis, laryngitis, throat neoplasm, chronic tonsillitis. In addition to cough, also manifested as nasal congestion, nasal secretions increase, frequent throat clearing, pharyngeal mucus and nasal drops after flu. Can be accompanied by nasal itching, sneezing, runny nose, sore throat, throat itching, increased pharyngeal foreign body sensation or burning sensation. Sometimes there can be hoarse voice. The laryngoscope in patients with oropharyngeal mucosa visible pebble like change or posterior wall with sticky purulent secretions. Nasopharyngeal CT can be seen as thickening of sinus mucosa, the appearance of liquid level in the sinuses. The first choice in the treatment of first generation antihistamines (e.g. ketotifen and chlorpheniramine) and decongestant. If it is accompanied by bacterial sinusitis, yellow pus pus, you need to use antibiotics as appropriate.
Eosinophilic bronchitis is characterized by the infiltration of eosinophils in the airways, which is characterized by chronic cough. Clinical manifestation of chronic cough, often is the only clinical symptoms, cough or cough a little white mucus sputum in the daytime or nighttime cough. The main difference between the CVA and the lung is the normal pulmonary function and no evidence of airway hyperresponsiveness. The diagnosis mainly depends on the proportion of more than 2.5% eosinophils in induced sputum cytology. Treatment of short-term oral or inhaled corticosteroids is very effective.
Gastroesophageal reflux cough due to gastric acid and other gastric contents reflux into the esophagus, causing clinical cough for the outstanding performance of the syndrome, a special type of gastroesophageal reflux disease, as well as a common cause of chronic cough. Typical reflux symptoms (heartburn and retrosternal burning sensation), belching etc.. Some gastroesophageal reflux induced cough with typical reflux symptoms, but there are many patients with cough as the only manifestation. Cough occurs mostly in the daytime and upright, cough or cough with a small amount of white phlegm. Eat acidic, greasy food is easy to induce or aggravate cough. In addition to clinical symptoms, the diagnosis mainly depends on the pH value of 24h esophagus. But the detection of very few hospitals have conditions to do so, for there was food related cough, with typical heartburn, acid regurgitation symptoms, in other treatment effect is poor, can try to take some drugs to inhibit gastric acid treatment (such as omeprazole 20mg, 2 times a day), can often work.
In addition to the main reasons for these cough, but also pay attention to other situations. Common causes such as hypertension patients taking Monopril and benazepril angiotensin converting enzyme inhibitors and antihypertensive drugs for chronic cough. Cough is a common adverse reaction of this type of antihypertensive drugs, the incidence rate of 10-30%, after stopping for other antihypertensive drugs cough will gradually improve. Also note that, today we speak of many cases in cough chest X-ray examination is no exception on the basis of chest radiography if problems are found, such as pneumonia, tuberculosis, bronchiectasis and so on, there will be other corresponding treatment. Moreover, the chest film sometimes has its limitations, some minor lesions on the lungs, chest X-ray can not be very comprehensive reflection. So, for some there is a long history of smoking, appear irritating cough and bloody sputum, chest pain, weight loss and other symptoms or changes in the nature of the original cough patients, we need to further make a lung CT to exclude the possibility of lung cancer. We have encountered a patient, but also a bad cough, cough in several hospitals have seen, in accordance with the formal treatment plan, with a long time and no effect. Results to our clinic on the view, a relatively low seniority doctor, see him cough for a long time, did not have lung CT, gave him a CT examination, the result is a early central lung cancer.
If you suffer from a cough, do not blindly use antibiotics, smoking friends should be able to quit smoking, but also try to avoid spicy spicy food consumption, but also need to go to the regular hospital for examination and treatment.