Una tosse… a clacson

Acute cough is a common symptom reflecting the body's protective reflex and is associated with many ailments beyond respiratory conditions. This study aims to assess the prevalence of acute cough, including its categorization, associated complaints, and conditions in adult and elderly patients in real-world settings in India. A retrospective analysis of electronic medical records (EMRs) was conducted to evaluate the prevalence and clinical features of acute cough in adult and elderly patients. Of 22,51,735 patients with cough complaints in the EMR, 64.06% were adults (18-65 years) and 10.39% were elderly patients (>65 years). Among the adult patients with cough complaints, nonproductive cough was prevalent in a higher proportion (16.34%) than productive cough (12.62%). Additionally, in 71.04% of adults, cough was not categorized and marked as unspecified cough. While in the geriatric population, productive cough (18.78%) was more common than nonproductive cough (14.80%). In 66.42% of geriatric patients, cough remained unspecified. A higher proportion of adult and geriatric patients visited consulting physicians (CPs) and general physicians (GPs). Respiratory tract infection (RTI) was the most frequently associated condition, followed by asthma, bronchitis, and other ailments. Fever and cold were common complaints among patients with both productive and nonproductive cough. This study underscores the substantial prevalence of acute cough in adults and the elderly population and the need for targeted strategies to manage it effectively. While cough categorization will help in symptom-targeted management approach for productive or nonproductive cough, the majority of cough patients are not yet categorized and are referred to as unspecified cough. This challenge persists irrespective of specialty of the doctors with a direct impact on patient outcomes.

Objective To investigate the clinical features and the response to treatment for clinical diagnosis of cough variant asthma (CVA) for the raising the level of clinical treatment. Methods We selected the CVA cases from the chronic cough cases with bronchial provocation test positive from respiratory medicine clinic in our hospital and Fuling central hospital from October 2009 to August 2010. The clinical features of cough and symptoms and throat symptoms from the suspected CVA cases were recorded, and then the cases were treated with Salmeterol/fluticasone dry powder (50/100 μg, twice a day) for 1-2 weeks. After 1-2 weeks, the results of treatments and clear diagnosis were evaluated through telephone or clinic follow-up. In addition to its study,the anti-asthma or cough drugs were disable during the treatment. It was statistics effect when cough improved 1/2 or more effective for the treatment. Results 46 patients were selected into this study, and 41 patients completed the follow-up study. Most of CVA patients were with nocturnal cough (87. 9%) and throat itching and other symptoms (87. 9%).Nearly half of CVA patients were with severe cough, and only 39. 0% of patients were with dry cough, and 45. 5% of patients were combined with rhinitis or sinusitis. Therapeutic efficacy was 80.5% (33/41). The clinical features of effective treatments patients and ineffective treatments patients showed that positive symptoms of cough and throat had no significant difference between two groups of patients, but the rate of patients with stomach or gastroesophageal reflux symptoms, there are signs of larynx and pharynx in ineffective treatment group was significantly higher trend than that in effective group.Conclusions Nighttime cough and throat itching symptoms are the majority features CVA.Determination of airway reactivity and anti-asthma treatment response are the main basis for diagnosis of CVA.The reasons of efficacy treatment should be in-depth study in the patients with ineffective treatment against asthma,not simply rule out the diagnosis of CVA. Key words: Cough variant asthma; Clinical feature

Objective To study the epidemiological and clinical characteristics of pertussis in infants younger than three months. Methods Infants younger than three months were enrolled from January 1, 2011 to December 31, 2015 with one or more of the following symptoms: persistent cough, spasmic cough, cyanosis of unknown causes, asphyxia and apnea. Multiplex polymerase chain reaction(PCR) assay was performed to identifyBordetella pertussisand enzyme-linked immunosorbent assay was used to detect antibody to pertussis toxin. Clinical features, complications, treatments and prognosis of the infants confirmed with pertussis were analyzed. Results Altogether 202 cases were enrolled in the five years, and 59 (29.2%) of which were positive for pertussis confirmed by multiplex PCR. Among the 59 cases, 37 were boys and 22 were girls. The youngest baby was 13 days and the oldest one was 85 days. Length of stay ranged from 7 to 21 days. Twelve cases had a contact history with family members having chronic cough. Symptoms occurred in spring or summer in 46 cases (78.0%), and in autumn or winter in 13 (22.0%) cases. Symptoms of spasmic cough, cyanosis after coughing, vomiting after coughing and conjunctival hemorrhage were respectively found in 41 (69.5%), 36 (61.0%), 39 (66.1%) and 33 (55.9%) cases, while only six (10.2%) presented with inspiratory whooping sound on coughing. Forty-nine cases (83.1%) showed increased lymphocyte count (≥10×109/L). Twenty-eight cases (47.5%) developed severe pertussis. Complications including apnea and bradycardia after coughing, respiratory failure and heart failure, pertussis encephalopathy as well as highly increased leucocyte count (≥60×109/L) occurred in 23 (39.0%), 18 (30.5%), five (8.5%) and four (6.8%) cases, respectively. Twenty-four cases with severe pertussis required respiratory support, of which six received invasive ventilation and 18 received non-invasive ventilation. Fifty-eight infants were recovered and discharged, while one baby died. Conclusions Bordetella pertussisinfection is an important cause of persistent cough in unimmunized infants under three months of age. The symptoms of pertussis in infants are untypical, but the incidence of severe pertussis is high.Thus early diagnosis and timely treatment are necessary. Key words: Whooping cough; Infant; Cough; Incidence

Objective To explore the relation between chronic and persistent cough of children and MP infection and clinical observation and treatment.Methods Retrospective Study of the 55 children chronic and persistent cough cases, with a clinical features as pneumonia MP infection, in my hospital from March 2005 to March 2008.Results ①Clinical Feature:major symptom of these 55 children chronic cough cases is chronicand persistent cough.58%(32/55)of the cases showed no symptoms in their lungs.②Peripheral Blood:85％(47/55)cases showed no obvious changes in peripheral blood, with their WBC ranging from(4～10)×109/Land their eosinophile granulocyte increased.③Special Test:47.27%(26/55)IgM (MP-IgM)antibody positive,83.64%(46/55)cased showed pneumonia MP DNA specificity after PcR Test.④X-Rate Report:Results varied.Conclusion Pneumonia MP Infection is one of the pathogeny causing chronic and persistent cough of children.Treating the infection is a very important solution in curing chronic and persistent cough of children. Key words: Children; Chronic and Persistent Cough; MP; Clinical Observation and Treatment

Background:Cough is one of the multiple prolonged symptoms observed in patients who had coronavirus disease 2019 (COVID-19) infection.Objective:We assessed the clinical outcomes and identified factors contributing to cough persistence in patients post-COVID-19.Methods:This retrospective cohort study included adults who visited a specialist cough clinic between 2022 and 2023. All participants underwent systematic investigation and treatment for persistent cough. Cough persistence was assessed at the 2- and 12-month follow-ups. Participants were classified as having persistent cough if they had a current troublesome cough at the 2- and 12-month follow-ups, and a cough severity visual analog scale (VAS) score change below 30.Results:Sixty-six patients (mean age 48.7 years; 72.7% women) were analyzed and divided into 2 groups: persistent cough (33.3%) and remitted cough (66.7%). The persistent cough group had a significantly higher prevalence of abnormal laryngeal sensation, sputum production, breathing difficulty, and airway eosinophilia; their VAS score changes at 2 months were also lower. Multivariable analyses indicated associations between persistent cough at 1 year and factors such as airway eosinophilia (adjusted odds ratio [aOR], 6.78), abnormal laryngeal sensation (aOR, 6.42), and low cough VAS reduction (aOR, 1.05).Conclusion:Persistent cough remained a significant issue for one-third of the patients after COVID-19. The clinical features commonly observed in chronic cough were also present in those who have experienced COVID-19, which contributed to prolonged cough. These findings underscore the need for systematic assessment and tailored treatment strategies to effectively manage persistent cough in patients post-COVID-19.

IntroductionPostinfectious bronchiolitis obliterans is characterized by persistent symptoms and signs of obstructive pulmonary disease following acute bronchial injury. It usually occurs with persistent wheezing and cough as a result of...

Association of novel adult cough subclasses with clinical characteristics and lung function across six decades of life in a prospective, community-based cohort in Australia: an analysis of the Tasmanian Longitudinal Health Study (TAHS)

Objective To investigate the clinical features of neonatal lower respiratory tract infection (LRTI) with respiratory syncytial virus(RSV), and to explore the relationship between clinical features and recurrent cough or wheezing after discharge. Methods From May 2008 to May 2013, the data of 41 neonates diagnosed as LRTI with RSV infection in New Century International Children's Hospital were analyzed retrospectively.The clinical features and follow-up results were observed. Results All the neonates had cough, 92.7% (38/41 cases) had choking, 85.4% (35/41 cases) had runny nose and nasal obstruction, 31.7% (13/41 cases) had fever, 65.9%(27/41 cases) had whee-zing sound during physical examination, 29.3%(12/41 cases)of the neonates were accompanied with bacterial infection(n=29), in which 50.0% (6/12 cases) were infected by staphylococcus aureus.Compared to the neonates only with RSV infection, the proportion of fever was higher in those with RSV combined with bacterial infection(n=12) (χ2=6.034, P<0.05), and there were no statistical differences between the neonates with or without bacterial infection in white blood cell count and with or without shadow in chest X-ray(χ2 =0.859, 2.064, P=0.485, 0.202). Compared with the neonates without family history of atopy, the neonates with the family history of atopy were more likely to get wheezing (88.2%vs 57.1%, χ2=4.871, P<0.05)during primary infection.During the follow-up, there was higher proportion of children with family history of atopy in the group with subsequent recurrent cough and/or wheezing than in the group without subsequent recurrent cough and/or wheezing(71.4% vs 26.3%, χ2=6.388, P<0.05). Conclusions Cough, choking are most common symptoms in neonatal LRTI with RSV, and there is no wheezing sound during phy-sical examination in some neonates.LRTI with RSV is likely combined with bacterial infection.Wheezing is more common in the neonates with family history of atopy.The RSV LTRI neonates with family history of atopy incline to get subsequent recurrent cough or wheeze after discharge. Key words: Respiratory syncytial virus; Lower respiratory tract infection; Follow-up; Family history of atopy; Recurrent cough or wheeze; Infant, newborn

To analyze the clinical characteristics of protracted bacterial bronchitis (PBB) in children. The clinical data of patients seen from October, 2010 to March, 2014 in Department of Respiratory Diseases of our hospital were retrospectively analyzed. Inclusion criteria were over 4 weeks cough, receiving fiberoptic bronchoscopy, positive bacterial culture and (or) the increased percentage of neutral granulocytes in bronchoalveolar lavage fluid (BALF). Twenty eight patients were involved, 26 were male (93%) and two were female (7%). The median age of patients was 8.5 months. The median duration of cough was four weeks. The average length of hospital stay was (8.3 ± 3.9)days. The main clinical feature was wet cough in 28 cases, wet cough with wheezing was seen in 21 cases. The wet cough phase distribution was irregular in 21 cases. The crackles with wheeze (in 21 cases) was main signs of PBB. The percentage of CD3⁻ CD16⁺ 56⁺ cells increased in peripheral blood. The fiberoptic bronchoscopic manifestations of PBB were luminal mucosal edema. Eleven patients also had airway malacia. The neutrophil median in BALF was 0.2. The positive rate of bacterial culture of BALF was 36%. The main bacteria were Streptococcus pneumoniae (50%) and Haemophilus influenzae (30%). The main treatment for PBB patients included amoxycillin/clavulanate potassium and second-generation cephalosporins. The average duration of treatment was (17.3 ± 3.2)days, the prognosis was good. PBB is common in male infants. Persistent wet cough with wheezing was the main characteristic of PBB. PBB is commonly accompanied by immune dysfunction and airway malacia, and the pathogens were Streptococcus pneumoniae and Haemophilus influenzae.

Objective To analyze the clinical characteristics in children with pertussis, and to provide a scientific basis for treatment of pertussis. Methods Retrospective analysis of general data, symptoms, signs, auxiliary examinations, treatment and prognosis was performed on the patients with pediatric pertussis in Xi′an from January 2015 to December 2016; the epidemiological data were analyzed by using descriptive approach. Results In a total of 857 patients with pertussis, there were 469 males and 388 females (the gender ratio of 1.211.00), 183 cases (21.3%) from the urban areas and 674 cases (78.7%) from the rural areas.The cases were reported throughout the year, indicating 2 peak times of onset: 355 cases (41.5%) from July to September and 218 cases (25.4%) from February to April.And 473 cases (55.2%) were younger than 6 months; 479 cases (55.9%) were inoculated with diphtheria, tetanus and pertussis combined vaccine(DTP) vaccine; 492 cases (57.4%) were exposed to their family members who coughed at that time.Cough was the main symptom, and the median duration of pertussis from onset to diagnosis was 20 days.Concomitant symptoms included spasmodic cough was relieved in 836 cases (97.5%), facial suffusion in 806 cases (94.0%), peri-oral cyanosis in 308 cases (35.9%), asthma in 269 cases (31.4%), crow-like echo in 248 cases (28.9%), and apnea in 46 cases (5.4%); pulmonary moist rale was found by check-up in 761 cases (88.8%), and fever was observed in 159 cases (18.5%). The increased proportion of the peripheral blood lymphocytes was found in 702 cases (81.9%), the increased total count of leukocytes in 505 cases (58.9%), the increased procalcitonin(PCT) in 36 cases (4.2%) and the elevated level of high sensitivity C reactive protein(hsCRP) in 17 cases (2.0%); pneumonia was suggested by chest radiography in 673 cases (78.5%); in the blood-gas analysis, hypoxemia was suggested in 50 cases (5.8%) and respiratory failure in 9 cases (1.1%). In the 857 patients with pertussis, 59 cases (6.9%) were with severe-type pertussis.At 1 week of the treatment, no spasmodic cough was reported in 515 cases (60.1%) and obviously relieved spasmodic cough in 198 cases (23.1%), and no deaths occurred. Conclusions The cases of pertussis occur throughout the year in Xi′an, predominately from July to September and February to April.A higher incidence is reported in the rural areas, compared with the urban areas, particularly in those younger than 6 months with incomplete DTP vaccination, who usually have severe conditions.In many cases, those with pediatric pertussis are infected by family members; most of them have spasmodic cough with good prognosis, without typical clinical signs. Key words: Pertussis; Epidemiologic characteristics; Clinical characteristics

Objective To investigate the cough variant asthma clinical features and treatment measures.Methods Retrospective analysis of clinical data of 80 patients.Results The patients were diagnosed with pre-antibiotics,antiviral drugs and various drug treatment cough phlegm,but persistent unhealed,diagnosed after the application of salmeterol and fluticasone propionate(Seretide)inhaler,with traditional Chinese medicine expectorant Tongluo,2 d onset after 1 week,clinical symptoms were disappeared,and continued maintenance therapy 2 to 3 months,reduced emissions,the condition was basically stable.Conclusion CVA,once diagnosed,the treatment of asthma treatment should be adhered to the principles of long-term,sustainable,standardized,individualized hormone therapy of bronchial dilator.Clinical repeated on adult patients with intractable cough,It should make asthma-related checks to confirm or exclude the presence of CVA,reduce the misdiagnosis and misuse CVA rule. Key words: Cough variant asthma; The clinical features; Diagnosis and treatment

To summarize the clinical characteristics of whooping cough in children and analyze the risk factors for severe whooping cough. A retrospective analysis was made on the clinical data of 247 children with whooping cough in Children's Hospital of Chongqing Medical University between Jan 2013 and Dec 2014. Of these patients, 126 were male, 121 were female, the median age was 3.1 months (23 days-4 years and eight months old). The patients were divided into two groups, group 1 had infants less than 3 months of age (n=120) and group 2 had infants and young children older than 3 months (n=127) according to their age. On the other hand, the patients were also divided into two groups according to vaccination status: vaccinated group (received diphtheria toxoid, tetanus toxoid, and acellular pertussis, DTP) (n=31) and unvaccinated group (n=188). Pure Bordetella pertussis infection was seen in 106 cases, and 141 cases had mixed infection. Severe disease was seen in 13 cases, and the other 234 cases had the modest disease. Clinical data were retrospectively analyzed and compared. (1) Bordetella pertussis was identified in 57/680 cases (8.4%) in 2013, and 190/1 856 cases (10.2%) in 2014. The disease could be seen throughout the year, but 182 cases (73.7%) occurred in summer or autumn; 202 cases (81.8%) were less than 6 months. (2) Paroxysmal cough was seen in 238 cases (96.4%) , 61 cases (24.7%) had inspiratory whoop. Infants in group 1 often had episodes of cyanosis, apnea and suffocation (χ² = 19.999, 12.081, 6.508, P<0.05), persistent cough was often seen in group 2 (χ² = 9.885, P<0.05). Complications such as severe pneumonia, pulmonary consolidation and encephalopathy were more common in the group 1 than in group 2 (χ² = 17.340, 6.080, 11.030, 23.545, P<0.05). (3) The length of stay of group 1, and of unvaccinated group was significantly longer than that of group 2 and of vaccinated group (t=19.331, 26.741, P<0.05). (4) Leukocytosis was found in 224 cases (90.7%), 182 cases (73.7%) had predominant lymphocytosis. White blood cell in group 1, unvaccinated group and severe disease group was higher than the corresponding group (t=11.075,13.739,3.469, P<0.05). (5) Patients who had a history of exposure, fever, leukocytosis and pulmonary consolidation or atelectasis on chest imaging were prone to develop into severe pertussis (OR=4.521, 4.900, 1.085, 4.792, 50.400; P<0.05). A total of 244 cases (98.8%) recovered, 3 cases (1.2%) died, they were less than 3 months old and unvaccinated. The number of cases with whooping cough in Chongqing area tends to be rising. The disease occurred mostly in summer and fall. Infants less than 3 months old, unvaccinated with DTP had high susceptibility to pertussis, often had a severe clinical presentation and severe complications, had a high mortality rate.

To investigate the drug resistance of Mycoplasma pneumoniae among children with community-acquired pneumonia (CAP), and to explore the clinical and radiological characteristics of and the role of azithromycin in the treatment of of macrolide-resistant (MR) Mycoplasma pneumoniae pneumonia. Cases of CAP in children (n = 179) were prospectively enrolled in the Pediatric ward of Beijing Chaoyang Hospital from 1st September, 2010 to 31st August 2011. Pharyngeal swabs were collected for detection of Mycoplasma pneumoniae DNA. Mycoplasma pneumoniae culture and in vitro susceptibility testing were also performed. Eighty-three cases met the diagnostic criteria of mycoplasma pneumonia, accounting for 46% of the CAP patients. Mycoplasma pneumoniae culture was positive in 45 cases, including 44 highly resistant to macrolides (MR) in vitro, and 1 sensitive. The 44 cases caused by MR pathogen presented with fever for (8 ± 3) d and cough for (17 ± 5) d, with higher fever (39.5 ± 0.7) °C and more irritating dry cough. In most of the children, peripheral blood leukocytes (8 ± 4)×10(9)/L were normal, with normal or elevated (0.60 ± 0.94) neutrophils, normal or slightly elevated erythrocyte sedimentation rate [(24 ± 14) mm/1 h] and CRP (12.8 mg/L). Chest X-ray showed lobar consolidation in 10 cases (23%, 10/44), among them 3 in the lower left lung, 2 in the left lung, 3 in the right lower lung, 2 in the right upper lung. Pleural effusion (small amount), combined with right lower lung consolidation, was found in 1 case. Patchy shadows were found in 27 cases, and interstitial lung infiltrate in 7 cases. Of the 44 cases caused by MR Mycoplasma pneumoniae, 19 had lung computed tomography (CT) scanning, among them 13 had lobar or segmental consolidation. Azithromycin therapy started in an average of 4.0 days after onset of illness, with duration of therapy averaging (9 ± 4) d. Cephalosporin or penicillin (n = 1) was the initial antibiotic choice in 12 of them, while combination therapy with azithromycin and cephalosporin or penicillin antibiotics was given in 41 of them. The duration of fever averaged (6 ± 3) d after treatment of azithromycin and duration of cough averaged (17 ± 5) d after treatment. Among patients with MR Mycoplasma pneumonia, those with lobar consolidation had longer duration of fever after treatment with azithromycin, compared with those without consolidation (P < 0.05). The macrolide resistance rate was 98% (44/45) in our patients. Fever and duration of therapy with azithromycin in MR infection was longer in patients with lobar consolidation. The 44 children with MR Mycoplasma pneumonia recovered with no serious complications.

Acute cough

To identify the risk factors which will indicate the Pneumocystis carinii (Pc) infection in children with systemic lupus erythematosus (SLE) and investigate the clinical features and to elevate the level to find out the high-risk patients and make early diagnosis and treatment. The characteristics, clinical features, laboratory examinations, treatment and prognosis of Pneumocystis carinii pneumonia (PCP) in children with SLE under 18 years of age treated in our hospital between January 2000 and January 2013 were prospectively reviewed. A comparison was made with the 26 cases of SLE children without PCP who were matched for gender, age and course, and a literature review was made. (1) Five cases were enrolled, 3 were male and 2 female. Their age range was 13-17 (14.0 ± 1.6) years. All the children had kidney involvement. The courses were from 3 months to 4.5 years. All patients were receiving daily glucocorticoid therapy and immunosuppressive drugs before the diagnosis of PCP.Four patients were in the inactive phase of SLE (SLEDAI 2-4 points), and the fifth case was in active phase (SLEDAI 8, low complement 2 points, anti-dsDNA antibody positive 2 points, urine-protein 4 points). (2) Besides the clinical manifestations of SLE, most patients had progressive dyspnea, fever and dry cough at onset of PCP. Two children accepted mechanical ventilation because of respiratory failure. The mean duration of the symptoms to diagnosis was 10-30 (17.6 ± 7.8) days. Lactose dehydrogenase (LDH) was elevated more or less, median was (700 ± 263) U/L. Lymphocyte count were (0.3-1.4)×10(9)/L (median 0.5×10(9)/L), and three children had CD4 T lymphocyte count <0.3×10(9)/L. Arterial blood gas analyses showed severe hypoxemia. Chest radiographs showed in all cases diffuse interstitial infiltration. Pc was positive in the sputum. All patients were treated with trimethoprim-sulfamethoxazole and corticosteroids. When SLE children are treated with corticosteroids and immunosuppressive drugs, low lymphocyte count is the risk factor for Pc infection.It is essential to monitor lymphocyte count.We should pay more attention to fever, dry cough and hypoxemia. Chest radiologic examination may help diagnose the PCP in SLE children.It may be helpful for SLE children whose CD4T lymphocyte was below 0.3×10(9)/L to take trimethoprim-sulfamethoxazole for PCP prophylaxis.