Подострый кашель у детей дошкольного возраста: дифференциальная диагностика и дифференцированная терапия в условиях амбулаторной практики

Abstract

The multifactorial nature of subacute cough, combined with the anatomical and physiological characteristics of preschool children, the impossibility of their full examination in outpatient practice, complicates its diagnosis. An algorithm for the differential diagnosis of acute respiratory infections accompanied by subacute cough in preschool children has been developed, it can contribute to the early identification of its causes and targeted treatment of the disease that caused the cough. A sequence of diagnostic measures is proposed, it includes anamnesis of life and diseases with a list of key questions that should be asked when collecting anamnesis in children with prolonged cough; objective examination of the child; determination of the tactics of further management (inpatient or outpatient); the choice of therapy that is comparable to the intended diagnosis; and evaluation of ongoing therapy. The emphasis is made on the importance of a full-fledged collection of anamnesis, taking into account the data of the time and conditions of the disease, and clinical data for making a presumptive diagnosis in an outpatient practice. It is recommended to carry out trial therapy if the diagnosis is difficult. The article presents modern approaches to the diagnosis of bronchial asthma in children with recurrent virus-induced vising. The modern approaches to the diagnosis and treatment of acute respiratory infections of the upper and lower respiratory tract are outlined in accordance with the principles of evidence-based medicine. It is noted that the most effective methods of treating cough are etiological and pathogenetic approaches, which consist in eliminating or weakening the action of factors that cause cough. It is emphasized that if treatment is impossible or insufficient, symptomatic cough therapy should be carried out. The main directions of symptomatic treatment of cough have been substantiated, which include measures to improve the drainage function of the lungs and restore adequate mucociliary clearance. The expediency of using ambroxol and acetylcysteine preparations was confirmed. Attention is also paid to the use of centrally acting antitussives. Discussion of the problem «to treat or not to treat subacute cough in acute respiratory infection of the upper respiratory tract» from the standpoint of evidence-based medicine is shown. No conflict of interest was declared by the authors. Key words: children, subacute cough, acute respiratory infections.