咳嗽

咳嗽是身体的一个保护反射，是种使呼吸道有效的清除异物和炎性物质的措施。咳嗽分为干咳和湿咳（咳嗽有痰）， 也有不同声音和性质的咳嗽，如百日咳，犬吠样咳嗽等。严重的咳嗽不一定都是肺炎， 肺炎不一定咳嗽很重。

病因

   呼吸道感染： 如鼻腔、鼻窦、气管、支气管、肺脏的感染，最常见的是病毒性感染，如感冒。

   鼻腔分泌物反流：感冒和过敏性鼻炎都会引起。

   过敏和哮喘。

   吸入的空气中有刺激性物质，如：香烟，雾霾等。

   体育活动：有哮喘或支气管痉挛的病人常在运动时引发咳嗽。

   胃酸反流刺激支气管引起咳嗽。

   习惯性咳嗽：特点是白天咳，晚上睡着后不咳。

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诊断

医生需要详细询问病史，了解咳嗽的特点和性质，如：是干咳还是湿咳；是否有呼吸困难或喘息；咳嗽发作的时间，频率和轻重；是否伴随有其它症状如发热等等来做出诊断。有时需要拍胸片和做其它辅助诊断方式来帮助诊断。

治疗

根据病因和诊断，医生会采用针对性的治疗方法。 有时不需要用任何药物，注意观察就可以了。

大于两岁的孩子，如果是由感冒引起的干咳，没有呼吸困难，可以适量服用止咳药缓解症状。 因为咳嗽是呼吸道排除分泌物的有效措施，所以湿咳一般不建议使用止咳药。 所谓的“化痰药”效果甚微或无效，也不提倡。如果是哮喘引起的咳嗽，则应用支气管扩张剂，有时甚至需要激素治疗。

如果咳嗽是由呼吸道感染造成如鼻窦炎，肺炎，则应用抗生素对因治疗。

常见的误解

1.   严重的咳嗽会咳出肺炎？

许多家长担心孩子咳的厉害最后会变成肺炎。 事实上，肺炎是感冒引起的不常见的合并症，而非一种常见的疾病。 多数孩子患感冒后会自愈。有些感冒引起的咳嗽比较严重，但孩子精神不错，没有呼吸困难，那么就不太可能会引发肺炎。肺炎是肺部的炎症，若孩子患有肺炎的话，会影响氧气和二氧化碳的气体交换，从而表现为呼吸困难。而且，肺泡上的咳嗽感受器较少，所以肺炎患者反而不太咳嗽了。

2.   我的孩子需要咳嗽药来治疗咳嗽。

许多家长因为担心孩子会咳成肺炎，所以都倾向于与孩子使用咳嗽药。事实上，不是所有的咳嗽都需止咳药治疗，也不是所有的治疗都是安全的。

美国儿科医学学会的指南中写道：4岁以下的孩子应禁止使用感冒药包括止咳药，没有科学证据可以证明感冒药的有效性，相反却会给婴幼儿带来严重的副反应。

所以在面对咳嗽时，明确病因至关重要，然后才是制订治疗方案。有时不予治疗就是最好的治疗。

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Cough

Cough is an important protective action that allows the body to clear mucus or other material from the respiratory system. Cough can be dry or wet (productive); it can be whooping or barking. Severe cough may not be due to pneumonia, and pneumonia may not have a severe cough.

CAUSES

Respiratory infections: an infection in the nose, sinuses, airways, or lungs. These infections are most commonly due to a virus as in the common cold.

Mucus dripping back from the nose .

Allergies. Asthma

Irritants in the environment such as smoke exposure.

Exercise induced cough as in asthmatics.

Acid backing up from the stomach into the esophagus (gastroesophageal reflux).

Habit. This is a cough that occurs without an underlying disease. It disappears when asleep.

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DIAGNOSIS

Your pediatrician will inquire for a detailed history from you, consider what kind of cough your child has (dry or productive), the nature and quality of the cough, the timing and severity, and whether there are other symptoms along with it. Your pediatrician may occasionally need to order tests to determine why your child has a cough.

TREATMENT

The treatment is determined by the cause or the diagnosis. Sometimes, no treatment, just watchful waiting, is the best approach.

If your child is over 2 years old, has a dry cough due to the common cold, a cough suppressant prescribed by a pediatrician can be used to reduce the symptom.

If the cough is caused by asthma or wheezing, a bronchodilator and even steroids might be used as treatment.

For respiratory infections such as sinusitis, or pneumonia, antibiotic treatment is the right choice.

THE COMMON MYTHS ABOUT COUGH

Is a bad cough pneumonia?

Many parents worry that if their children have “a bad cough” it may cause pneumonia. In fact, pneumonia is not a common disease. It is a uncommon complication of the common cold. Most children who have a cold, will get better on their own. If your child has a bad cough, but looks good and active, no trouble breathing, then pneumonia is very unlikely the cause. Since pneumonia is the infection in the lungs, where the exchange of O2 and CO2 is taking place, most of the time, children who have pneumonia will have shortness of breath. In addition, there are not many cough receptors located in the air sags, people who have pneumonia may not cough much.

My child needs cough medicine to treat cough.

Many parents because of concerns of pneumonia tend to treat their children with cough medicine. In fact, cough doesn’t always need to be treated. And treatment is not always safe.

According to the guidelines by American Academy of Pediatrics, it is not advisable nor safe to use cold medicines including cough medicines on young children less than 4 years old. There is no evidence that cold medicines or cough medicines are efficacious. Further, they can cause severe side effects on these young children.

Therefore, when treating a cough, it is important to make the diagnosis, then formulate the treatment plan. Sometimes, no treatment is the best treatment.

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