儿童慢性咳嗽的症状表型
2017/10/09
摘要
儿童中的慢性咳嗽是指持续四周以上的咳嗽。目前普遍认为儿童慢性咳嗽与成人不同。因此，关于儿童慢性咳嗽的诊断和管理方式不可照搬成人咳嗽指南。儿童气道、免疫系统和神经系统的特点不同决定了儿童和成人咳嗽之间的差异性。针对儿童慢咳的指南和规范正在被广泛应用中。感染后咳嗽、哮喘、支气管扩张、软化症以及迁延性细菌性支气管炎（PBB）被认为是引起幼儿咳嗽的常见病因。在青少年中，咳嗽的病因与成人更为相似，如胃食管反流、哮喘、上气道综合征。在初始治疗中，有必要对可以诱发并维持慢性咳嗽的潜在疾病进行探究。咳嗽管理方案或流程图的应用可以改善疾病的临床转归，且其方案的制定应根据咳嗽特点及患儿病史而定。完善病史采集及体格查体对于个体化治疗的开展很关键。那么，对于症状表型的正确诠释可以指导临床治疗，并有益于疾病的妥当管理，避免不适当的检查或不充分的治疗。
Phenotypic presentation of chronic cough in children.
Kantar A.
Paediatric Asthma and Cough Centre, University and Research Hospitals, Gruppo Ospedaliero San Donato, Bergamo, Italy.
儿童中的慢性咳嗽是指持续四周以上的咳嗽。目前普遍认为儿童慢性咳嗽与成人不同。因此，关于儿童慢性咳嗽的诊断和管理方式不可照搬成人咳嗽指南。儿童气道、免疫系统和神经系统的特点不同决定了儿童和成人咳嗽之间的差异性。针对儿童慢咳的指南和规范正在被广泛应用中。感染后咳嗽、哮喘、支气管扩张、软化症以及迁延性细菌性支气管炎（PBB）被认为是引起幼儿咳嗽的常见病因。在青少年中，咳嗽的病因与成人更为相似，如胃食管反流、哮喘、上气道综合征。在初始治疗中，有必要对可以诱发并维持慢性咳嗽的潜在疾病进行探究。咳嗽管理方案或流程图的应用可以改善疾病的临床转归，且其方案的制定应根据咳嗽特点及患儿病史而定。完善病史采集及体格查体对于个体化治疗的开展很关键。那么，对于症状表型的正确诠释可以指导临床治疗，并有益于疾病的妥当管理，避免不适当的检查或不充分的治疗。
（中国医科大学附属一院呼吸与危重症学科 李文扬 摘译 杨 冬 审校）
（J Thorac Dis. 2017;9(4):907-913.）
（J Thorac Dis. 2017;9(4):907-913.）
Phenotypic presentation of chronic cough in children.
Kantar A.
Paediatric Asthma and Cough Centre, University and Research Hospitals, Gruppo Ospedaliero San Donato, Bergamo, Italy.
Abstract
Chronic cough in children is increasingly defined as a cough that lasts more than four weeks. It is recognized as a different entity than cough in adults. As a result, the diagnostic approach and management of chronic cough in children are no longer extrapolated from adult guidelines. These differences are attributed to the various characteristics of the respiratory tract, immunological system and nervous system in children. Specific paediatric guidelines and algorithms for chronic cough are now widely applied. Post-infectious cough, asthma, bronchiectasis, malacia and protracted bacterial bronchitis (PBB) appear to be the major causes of cough in young children. By adolescence, the causes of cough are more likely to be similar to those in adults, namely, gastroesophageal reflux, asthma, and upper airway syndrome. In a primary setting, it is essential to investigate the underlying disease entity that initiates and sustains chronic cough. The use of cough management protocols or algorithms improves clinical outcomes and should differ depending on the associated characteristics of the cough and the child's clinical history. Performing a thorough history and physical examination is crucial to starting an individualised approach. A correct interpretation of the phenotypic presentation can be translated into guidance for workup. This approach will be helpful for adequate management without the risk of inappropriate investigations or inadequate treatment.
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总体人群中抽样14,669名受试者慢性咳嗽的危险因素
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