Middle of the night. Everyone is asleep. Peace and quiet. Until yesterday there was no sign of the coming catastrophe. When suddenly your child’s COUGHING wakes you from deep sleep. Coughs once .. twice .. Oh no .. it Coughs more and more. What’s going on? Do you know this feeling? If so, this article is for you.

Coughing is one of the most common reasons for seeing a doctor, and to be honest, it’s a good thing that it is like that. Why? Because as a symptom, it represents many different causes – from the simple and most common ones, to those that threaten the child’s health. Coughing is also a symptom that is difficult for a parent to describe, and it is problematic to describe it correctly. What to look for and what’s more, what and why will the doctor ask during the visit?

Let’s start from the beginning.

Coughing is a defensive reaction of the body. A healthy person coughs about 10 times a day. During breathing a lot of dirt gets into our respiratory system – fine pollen, bacteria and viruses – it happens with every breath. Fortunately, the respiratory system has defense mechanisms to remove all this unnecessary mess on a regular basis. The structure of the respiratory epithelium – the layer that covers the inside of the respiratory tract – provides several protective mechanisms that create a filter for the air reaching there. Purification involves the mechanical removal of pollutants from the air, the retention of dust with the mucus produced by the respiratory epithelial cells and the removal of substances deposited on the walls of the epithelial cilia with a constant movement (always upward). As if that were not enough, there is also a mechanism of local immune response and phagocytosis, i.e. literally eating foreign substances by defense cells.

However, when this balance is disturbed, e.g. as a result of the ingress of a virus and the onset of inflammation in the respiratory tract, the excess secretion exceeds the capacity of the cilia, which are damaged as a result of the inflammation. Another defensive reaction of the body appears- coughing.

A cough is a violent, turbulent expulsion of air from the airways.

When observing a cough, it can be divided into 3 short phases (each of them lasts about 0.8 seconds)

• deep breath,
• closure of the glottis with relaxation of the diaphragm and a sharp contraction of the expiratory muscles
• the opening of the glottis and the explosion of air from the lungs to the outside

• 

  

In the cough series, each subsequent reflex is less intense and less effective.

Since coughing is a desired normal defense reaction of the body, why does it stress the parent, why are there sleepless nights when it is difficult to calm down this cough? Why is the child coughing persistently and paroxysmal one time, and sometimes the cough is sporadic?How do you even know what kind of cough it is? When is it necessary to be concerned?

And here I come back to the first statement – without visiting a doctor and auscultation, it is impossible to answer this question unequivocally. The interview itself – i.e. a series of questions about the symptom, directs the doctor to the right track, while examination and auscultation are key to confirm the diagnosis.

The first question of the interview is usually “Since when is the child coughing?”

This information alone allows the cough to be classified to the appropriate time group as:

• acute cough (lasting up to 3 weeks),
• subacute (3-8 weeks) or
• chronic (over 8 weeks).

Thanks to this information, we narrow down the source of searching for the cause of acute cough to: respiratory tract infections, allergies, foreign bodies or irritating dusts and gases. We do not suspect severe lung disease after coughing for several days.

The next step in searching for the cause of cough is to define whether the cough is wet or dry.

The dry cough is persistent, paroxysmal, unproductive, hoarse or barking in sound, and older children may complain of a tickling or scratching sensation in their throat. The source of dry cough is the upper respiratory tract – nose, sinuses, throat, larynx, trachea – as a result of infection, the respiratory epithelium is damaged, making the cough receptors more sensitive to the smallest stimuli – even air flow. Dry cough occurs day and night.

A wet cough is a cough associated with the coughing up of mucus, so it is productive. It is deeper and less tiring than a dry cough. Usually it intensifies in the morning (after the night the respiratory tract has to clear of any residual content) or sometimes at night, but it subsides after expectoration.

Attention !

Both types of cough can be intertwined, because almost every lower respiratory tract infection is associated with upper respiratory symptoms. Usually, at the beginning of an acute infection, a dry cough appears, related to the body’s reaction to the pathogen. The further development of symptoms depends on our immune system, how it is prepared, the type of pathogen attacking us and our health. Then a wet cough and productive expectancy appears. When the acute phase of infection subsides, bronchial hypersensitivity remains as a result of damage to the respiratory epithelium, which manifests itself as a dry cough lasting up to several weeks.

So what should you pay attention to when observing a child at home, so as not to overlook the dangerous causes of coughing?

After determining the type of cough (effective or non-productive) and the duration of the cough (acute, subacute, chronic), the doctor must exclude other causes of cough – the so-called alarm symptoms. We pay attention to the child’s age at the time of the appearance of the cough, whether the cough occurs during feeding, whether the onset was sudden, was it preceded by an infection, or the child’s development is abnormal, or there is excessive sweating. During the examination, the pediatrician assesses the patient’s clinical condition, looks for places of inflammation, auscultation can indirectly determine the level of residual contents or examine the features of bronchial hypersensitivity. Sometimes additional blood tests or imaging tests are needed.

Treatment of cough to be effective should be causal.

If we are dealing with a respiratory tract infection, we help in relieving its symptoms. We give antitussive drugs sporadically. As infections develop, our treatments will also change and adapt to the patient’s needs. However, it should be remembered that any change in the child’s health requires a new examination.

Infection is the most common, but not the only, cause of coughing. It is worth going to the doctor when our child’s cough worries us.

author:

 Agnieszka Purol MD