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Query: UMLS:C0010200 (cough)
 23,843 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Rational approach to diagnosis and management of recurrent respiratory infections is needed, or else the child is subjected to unnecessary investigations and multiple drugs. Repeated respiratory symptoms do not mean a respiratory infection. A diagnosis of viral infection does not justify prescription of an antibiotic. Recurrent viral infections are part of the growing up process of any child. Giving antibiotics at every episode to cover "so-called superadded bacterial infections" will lead to "recurrent antibiotics" and adverse effects on growth. Systematic approach should be used to find the underlying cause. An otoscopic examination of a child should form part of a pediatric examination in all cases of respiratory infections. Antibiotics should be judiciously chosen depending on age, socioeconomic status, severity of infection and the type of organism expected and always given in adequate doses and proper duration. Treatment should be specific and symptomatic. Adequate drainage of the sinuses is an important adjuvant therapy. Use of cough syrups with various combinations should be avoided. Efforts should be made to diagnose and treat manifestations of hyperactive airway or allergy, role of CEA (cough equivalent asthma) and WLRI (Wheeze associated lower respiratory infections). Investigations are needed in recent lower respiratory infections and adverse effect on growth, school performance, abnormal physical findings. CBC, CRP, ESR, nasal smear, appropriate cultures, tests for TB, X-Rays, barium studies, milk scan, ultra sound, CT, MRI, bronchoscopy in selected cases.
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PMID:Approach to recurrent respiratory infections. 1141 74

Infectious diseases of the upper respiratory tract are one of the most common health problems and antibiotics are used to treat them. The correct use of these drugs depends on a variety of factors: the doctor, the patient and the pharmaceutical industry. The objective of this study was to examine the knowledge, attitude and perception of patients with regard to antibiotics. The study was conducted by carrying out personal interviews with 600 adults and 200 childcare workers who had had a mild to moderate respiratory infection in the two previous months for which an antibiotic was prescribed. In general, the infections had little impact on the everyday lives of the patients, and were mostly categorized as coughing, flu or sore throat. Almost half of the patients waited for the doctor to prescribe an antibiotic when they had an appointment (42% adults and 47% caregivers). A total of 85% of the adults and 71% of the children were treated with penicillin. The majority improved in three days and felt they had recovered in six, a time period which was in accordance with the patients' expectations of the efficacy of the drug. The perception of efficacy was related to a faster initiation of symptomatic improvement or recovery, to short-term treatments, to the information received, and to a better attitude toward their doctor. In general, the patients felt satisfied with the attention they received and related this satisfaction to their trust in their doctor, the efficacy of treatment and the duration of their appointment. The use of antibiotics in mild to moderate respiratory infections is common, and they are often used to treat disease processes that seemingly do not require their use. To improve the use of antibiotics attention needs to be placed on the prescribers and on the consumers.
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PMID:[Knowledge, attitude and experience of the Spanish population with respect to antibiotics]. 1175 46

Influenza is a descriptive term for respiratory epidemic disease presenting with cough and fever. Influenza viruses are probably the most important of the pathogens that cause this condition. Clinical influenza occurs almost every winter in England and Wales and the outbreaks last 8-10 weeks. In recent years, influenza B virus outbreaks have occurred in January and February, whereas influenza H3N2 virus outbreaks have generally started long before Christmas. Influenza H3N2 virus outbreaks pressurize health service resources in winter more than influenza B viruses, that do not have the same impact in elderly people. Infections with influenza H1N1 viruses are also usually less severe in their impact than those with influenza H3N2 viruses, but, unlike influenza B viruses, influenza H1N1 viruses have a pandemic potential along with influenza H3N2 viruses. A diagnosis of respiratory infection in primary care is based on the presenting symptoms set within the context of the current pattern of consultations of patients with similar illness. Measurement of temperature, inspection of the throat and examination of the chest or ears add a little to the diagnostic process, but in general these procedures do not help in identifying the organism. However, if it is known that influenza viruses are circulating in the community, the probability of influenza as the cause is greatly increased, as was shown in clinical trials of neuraminidase antivirals. Maximum confusion occurs when respiratory syncytial virus (RSV) and influenza cocirculate. Although RSV infection can occur throughout the winter in young children, it assumes more of an epidemic character just before Christmas in children and possibly in adults just after. During seven of the last 20 winters, influenza has been prevalent around Christmas/New Year. In routine virological surveillance of influenza-like illness in the community during the winters of 1997, 1998 and 1999, ca. 30% of swab specimens yielded influenza viruses and 20% RSV. Given the limitations for routine surveillance, including variations in the interval between illness onset and specimen capture, the quality of swab, delays in transport, the growth properties of virus culture methods, etc., these figures probably underestimate the impact of both viruses in the community. The impact of influenza is considered against the background of total respiratory infections presenting to general practitioners over the last 10 years and some comparisons are made with the 1969 pandemic experience. Lessons relevant to pandemic planning are drawn. Current options for investigation and treatment are compared with those available in 1969. These include near-patient tests for assisting with diagnosis, widespread use of vaccination as a preventive in patients at increased risk, the availability of amantadine and the newer neuraminidase inhibitor antivirals and changes in the delivery of health care. Major advances in the understanding of influenza and improvements in investigation and treatment have taken place over the last 30 years. However, there are many obstacles before these can be translated into effective management of influenza sufferers and control of major epidemics.
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PMID:Influenza diagnosis and treatment: a view from clinical practice. 1177 94

Prolonged cough is a common problem in patients seen in general practice. Using a simple method of sputum induction and processing of sputum samples, we determined whether eosinophilic airway inflammation could be a cause of undiagnosed prolonged cough. Eighty-two patients who had had cough for more than 1 month were enrolled into the study, in six primary healthcare centres. Patients with known pulmonary disease, including asthma or chronic obstructive pulmonary disease (COPD), or who were known to have another cause of cough, or to have recently suffered from a respiratory infection, were excluded. Fifty-three healthy individuals served as controls. Sputum was induced by inhalation of 3% saline. Inflammatory cells in smears were studied semi-quantitatively. Concentrations of eosinophil cationic protein (ECP), eosinophil peroxidase (EPO), myeloperoxidase (MPO) and human neutrophilic lipocalin (HNL) were determined. Sputum induction proved safe and adequate samples were obtained from 91%. Sputum eosinophilia (eosinophils accounting for more than 5% of all cells in smears) was present in 14 patients with prolonged cough (19%) but in no healthy individual (P=0.001). Five of the 14 individuals (36%) who exhibited sputum eosinophilia appeared to have asthma, while nine of the 14 (64%) did not. Concentrations of ECP and EPO were higher in patients with prolonged cough than in healthy individuals (P=0.02 for ECP; 0.005 for EPO). We conclude that eosinophilic airway inflammation is a fairly common cause of prolonged cough, even in patients not suffering from asthma or COPD, or in whom no other cause of cough is known to be present. Induced sputum samples obtained in health centres can be studied in a central laboratory. Detection of eosinophilic airway inflammation could aid the decision regarding treatment.
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PMID:Eosinophilic airway inflammation as an underlying mechanism of undiagnosed prolonged cough in primary healthcare patients. 1186 10

"Kennel cough" in dogs in animal shelters is readily transmissible, reduces adoption rates, and commonly leads to the euthanasia of affected dogs. In cats, tracheobronchitis, conjunctivitis, and pneumonia have been associated with Bordetella bronchiseptica infection-but most cases of upper-respiratory infection (URI) probably are caused by herpesvirus and calicivirus, and many B. bronchiseptica culture-positive cats are clinically normal. Our prospective observational study was undertaken to document the contribution of B. bronchiseptica to disease in cats and dogs from two animal shelters undergoing outbreaks of canine kennel cough, to evaluate whether cross-species transmission might have occurred, and to determine if the presence of infected cats represented a risk to dogs. Clinically defined cases of kennel cough in dogs and URI in cats were investigated in two shelters by calculating clinical-disease incidence, alveolar-lavage cytological examination, bacterial and viral cultures, antibiotic-susceptibility testing, and molecular fingerprinting by pulsed-field gel electrophoresis. In a 40-cat and 40-dog "no-kill" shelter, the prevalences of culture positivity were 47% for B. bronchiseptica and 36% for calicivirus at the same time as two resident dogs demonstrated clinical cough. When no dogs had kennel cough 3 months later, 10% of cats were B. bronchiseptica-culture-positive and 63% calicivirus positive. In a large traditional shelter, the incidence of kennel cough in dogs increased over 12 weeks to a maximum of 19 cases/week/120 dogs, during which time the culture prevalence was 23% for B. bronchiseptica in dogs and 47% in cats. Three to 6 months before the kennel-cough epidemic, no dogs or cats were B. bronchiseptica positive. Very little genetic variability was detected in isolates from these shelters; all isolates except one corresponded to a single strain type which was identical to the pattern in a vaccine used in these shelters. Isolates from other cats, a horse, a llama, and a sea otter were genetically distinct from the shelter isolates. There was widespread resistance to cephalosporins and ampicillin, but low or no resistance to amoxicillin/clavulanate, trimethoprim-sulfamethoxazole, tetracycline, and enrofloxacin. Greater percent resistance was observed in the traditional shelter than in the no-kill shelter and feline isolates were more likely to be resistant than canine isolates.
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PMID:Molecular epidemiology of feline bordetellosis in two animal shelters in California, USA. 1206 77

The presented research positively evaluates the vocality of the cough sound by estimating the global cough fundamental frequency or pitch. The fundamental frequency was determined by autocorrelation analysis on both the original time-signal and the linear predicted time-signal. The experimental cough database was registered in the free acoustical field on respectively three pathological and nine healthy non-smoking human subjects and on two pathological and two healthy Belgian Landrace piglets. For both species differences between pitch values for cough-sounds originating from subjects suffering from a respiratory infection and healthy subjects are put forward. The retrieved pitch-difference between respectively healthy and infected subjects indicates the existence of acoustically different cough-classes in accordance with a different cause or physical condition of the respiratory system.
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PMID:Assessing the sound of cough towards vocality. 1223 50

Respiratory viruses and their complications are the most common diseases after dental caries, and the most important single cause of medical consultations. They are the 2nd leading cause of hospitalization and mortality in infants. The challenge in respiratory infections is to prevent complications. Since most respiratory infections are treated in the home, preventive interventions should begin there. Respiratory infections do not depend greatly on environmental conditions, they are not preventable by vaccination, and their course in the great majority of cases is self-limiting and benign. Respiratory viruses are characterized by a symptom complex which represents the reaction of the organism to the viral infection. Although the symptoms may be annoying, they play an important role in preventing bacterial complications. Nasal secretions contain substances that limit the virus and impede secondary bacterial infection. Nasal congestion should be treated only by aiding the evacuation of secretions. Nasal obstruction and resulting respiration through the mouth allow unfiltered air to reach the bronchial passages, causing irritation or contamination. Use of local or systemic decongestants or antihistamines may contribute to complications by decreasing defenses. Treatment of inflamed pharynx or tonsils with antiinflammatories is counterproductive because it too interferes with the body's defenses against viral invasion. Viral laryngitis should be treated only with steam vapor and never with steroids, which diminish the body's antiviral defenses and can produce serious side effects. Coughs are the body's means of evacuating viral secretions and should be aided only by ensuring adequate hydration to maintain the fluidity of the secretions. Expectorants should be used only in cases of chronic bronchitis. Coughs resulting from bronchial obstruction, cases in which bronchial dynamics are hyperactive, and dry and unproductive coughs resulting from pharyngeal irritation are the only ones that should be treated. Fever it probably the defense mechanism that has elicited the greatest treatment efforts. Lowering the fever through medication does nothing to fight the virus but makes children feel well enough to resume playing outside, thereby increasing the risk of secondary bacterial infection. Children with fevers should be kept hydrated. Only in the case of pain should medication be given to lower the fever. Aspirin should be avoided in children. An untreated fever provides information on the course of the disease: spontaneous decline followed by a rise may indicate bacterial infection.
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PMID:[Combatting fever, phlegm and cough]. 1234 10

During October 1992 to June 1993 in eight villages covered by the Primary Health Center Machhra in Meerut District, India, interviews with mothers and examinations of 1600 children aged less than 5 years (under-fives) were conducted to examine the relationship between acute respiratory infection (ARI) and malnutrition. 42.25% of all children had an ARI within the last 15 days. Most ARIs (73.4%) were considered mild (cough and cold with no pneumonia). Pneumonia accounted for 19.5% of all ARI cases, which were considered moderate. The remaining ARI cases were severe (severe and very severe pneumonia). 57.5% of all children suffered from protein energy malnutrition (PEM). 78.6% of children aged 12-14 months had PEM. ARI was more common among malnourished children than well-nourished children (52.2% vs. 28.8%; p 0.001). The incidence of ARI increased as the nutritional status deteriorated (p 0.05). It also increased as the midarm circumference decreased (p 0.001). These findings confirm the synergistic action between malnutrition and infection, in this case ARI. Malnourished children suffer considerable impairment in immunity, especially cellular immunity, which makes them more prone to ARI. These findings reinforce the need to strengthen the quality, quantity, and accessibility of nutritional services, particularly promotion of breast feeding and vitamin A supplementation.
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PMID:Nutritional correlates of acute respiratory infections. 1234

The aim of our study was to determine the prevalence of asthma and related respiratory symptoms in school children from Costa Rica during the last 10 years, from 1989 to 1998. Using nationally representative samples of school children from Costa Rica during the last 10 years we have performed three studies. Altogether 9,931 children were investigated. The age groups: study I, 5-17 years (n = 2,682), study II, 6-7 years (n = 2,944), 13-14 years (n = 3,200) and study III, 10 years (n = 1,105). The diagnostic criteria for asthma used in these studies was as follows: study I (1989), diagnosis by a doctor in combination with the presence of four kinds of respiratory symptoms; studies II (1995) and III (1998), history of wheeze in the past 12 months. The two latter were part of the International Study of Asthma and Allergies in Childhood (ISAAC). A very high prevalence of a history of wheezing was found in the three studies (46.8%, 42.9%, and 45.1%) as well as a diagnosis of asthma (23.4%, 27.7% and 27.1%). The physician's diagnosis of asthma reported in the first study (23%) increased from 23.1 in study II to 27.7% in study III (p = 0.004). This increment could be a real increase in asthma prevalence, or be due to a better awareness about asthma. In study II the group of 6-7-year-olds had respiratory symptoms significantly more often than 13-14-year-olds (p < 0.001). Boys more often had a history of wheezing (p = 0.001), wheeze during the previous 12 months (p = 0.01) and an asthma diagnosis at the age of 6-7 years (p = 0.002) than girls, but girls had more respiratory symptoms than boys at the age of 13-14 years (p < 0.005). Wheezing in the past 12 months was more common for those living in urban areas aged 6-7 years (p = 0.04), and there was an increase of wheeze after exercise (p = 0.01). For the 13-14-year-olds the risk of wheezing was higher during the previous 12 months if they lived in temperate areas (<20 degrees C) and at a high altitude (>1,000 m). Living in a rural area and in a warm region (>20 degrees C), increased the risk of dry cough during the previous 12 months in the group of 13-14-year-olds. In conclusion, Costa Rica is located in the tropics with a very high humidity, an enormous variety of flora and fauna and a very high prevalence of mite and cockroach allergens, which provide important risk factors that may explain the high prevalence of asthma and asthma-related symptoms. Further possible factors, such as the change towards a more Western life style, resulting in fewer infections and parasitic diseases in the first years of life and changes in bedding material, may also be unresolved. Increased environmental pollution may add to the very high prevalence of asthma and related respiratory symptoms. The very extensive exposure to mites and cockroaches in bed material and in homes with poor ventilation may be an important factor, but many asthmatic children behave as non atopic, with a viral respiratory infection as a major precipitating factor.
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PMID:Epidemiological studies of the very high prevalence of asthma and related symptoms among school children in Costa Rica from 1989 to 1998. 1243 Nov 93

The prevalence of bronchiectasis decreased due to the effective use of vaccines and advances of antibiotic therapy after 1970. However, it remains an important long-term morbidity of lower respiratory tract infection in developing country. To evaluate the clinical features of bronchiectasis in a tertiary hospital, we collected 21 patients with a diagnosis of bronchiectasis in Taipei Veterans General Hospital from May, 1984 to Dec, 2001 in pediatric outpatient with the admission of age below 18 years old. The diagnosis was based on the history of recurrent cough with fetid sputum, hemoptysis, or recurrent lobar pneumonia for months at least and radiological findings of lobar infiltration, tram-track like patterns, bronchiolar dilatation or honeycomb patterns. The diagnostic examinations included chest plain radiography, bronchography and chest computed tomography (CT) scans. Respiratory tract infections were the commonest cause predisposing to bronchiectasis in our study. Tuberculosis is not rare in this study. In recent years, immunodeficiency disorders have been recognized. Most patients suffered from recurrent cough and fetid sputum for years before diagnosis was established. Hemoptysis was the second common symptom in our study. The plain chest radiograph of bronchiectasis revealed dilatation of bronchial trees with honeycomb pattern or infiltration only. In recent years, chest CT became the most accurate and being noninvasive diagnostic tool. The initial treatment was primarily medical conservative therapy. Only five patients in our cases underwent pulmonary resection due to persistent hemoptysis, recurrent bacterial pneumonia or pulmonary parenchyma destruction. Most patients still suffered from recurrent pneumonia or occasional exacerbation in the long-term follow-up. In conclusion, bronchiectasis is not uncommon in pediatric population in northern Taiwan. The history of recurrent cough with fetid sputum, hemoptysis, or recurrent pneumonia were the most important clues to early diagnosis of this disease. Early diagnosis and appropriate treatment are effective in order to prevent lung abscess, empyema and pneumothorax, bronchopleural fistula, hemoptysis or cor pulmonale.
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PMID:Clinical spectrum of bronchiectasis in children. 1260 83


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